IVF patients need to learn that doctors don't have all the answers

Dear Dr Malpani,

I read your recent email with interest, as it relates directly to me.

After 5 years of IVF and only one successful transfer, which occurred last year at the age of 49 (2016) and I was pregnant for 11 weeks. Unfortunately the embryo failed at 11 weeks due to Edwards syndrome, but these were my own eggs from about age 46.

Since this, I have now done two transfers with donor eggs (23 year old donor) and neither has worked.

The only successfully pregnancy I had involved a treatment protocol designed by a fertility immunologist, as a result of extensive and expensive blood tests in the US (exactly a you describe - the only place they can be done is in Boston).  This treatment included Intralipid infusions, neuprogen injections, prednisolone tablets, clexane injections, as well as estrgoen patches and progesterone pessaries and then once I reached 6 weeks I had to have progesterone injections every second day (to keep my levels up).  NK cells are vey high, along with other immune issues.

From reading your email you are obviously very skeptical of this type of treatment, as I am also.  Not only is it expensive, time consuming and stressful, I also have many Dr's who say they do not believe it because it is untested and fringe.  However, as this is the only time I have achieved a positive pregnancy test, it is very hard for me to question the treatment protocol.  I have used Chinese medicine for the last 5 years, acupuncture, changed my diet to gluten free and reduced sugar intake.  I have read and followed many different people, as well as doing conventional treatment and none has achieved a result for me.

We now have 3 embryos left, made with the donor eggs.  We do not wish to waste these last few opportunities, so I am looking for your second opinion on what to do.  I have had Endometriosis removed from around my bowel, two surgeries for Ashermans syndrome (which were successful and confirmed with a hysteroscopy a year ago), I also have many fibroids but all outside the uterus.
The immune specialist believes the Endometriosis could be back and most likely the main cause of the implantation failure, along with the other immune issues.  He has asked for me to repeat the expensive blood tests ( a smaller panel of tests, as my last tests were over two years ago).  These results will take up to 6 weeks and then we will provide an analysis and a protocol to plan for the next transfer.

I am confused and skeptical, but also as your email says pretty desperate for answers after so many years and only one successful transfer.  These are the last embryos we have to use, so the last opportunity to get a result.

The Dr in Spain (where the embryos are) has suggested a Depot injection to block my cycle for 3 months, in order to reduce inflammation and then start again after that - preparing my system artificially with Estrogen patches and progesterone pessaries.  Which is just more of the same, what was done the last two cycles - which did not work.  I do not believe my lining was good enough (7+mm) and having just had a period after the negative pregnancy test which lasted for only one day - I believe that confirms the lining was insufficient.  I am told that is not an indication, but that is the smallest bleed i think I have ever had.

The US immunology Dr says I should not take the Depot  injection, this is not the right thing and they only suggest that as it is all that they know.  He wants me to re-do the blood tests, which I agree at least gives him a picture of where things are right now.  Then he will suggest a course of action.

What is your opinion?  Which action should I take.  Time of course is of the essence, so I need to make informed decisions based on thorough information.  As your article states, this is very difficult to find and from a lay persons perspective it is literally a mind field out there.

I value your thoughts and second opinion on my case.  If you need any further information, please let me know and I will send it through.

Thanks and regards,

This was my reply to her


I sympathise with you -  medical ignorance can be extremely frustrating.

As you know, I do not believe either the endometriosis or the immune issues affect implantation

The fact that you got pregnant after the "immune treatment protocol" could very well just be a coincidence

I wish I had more scientific answers to give you, but I will not pretend to know more than I do

Why good looking embryos do not implant is still one of those things we do not understand - it is
one of medicine's unsolved mysteries !

Human reproduction is not very efficient - and both IVF specialists need to make our peace with this unpleasant  fact of life.

I am a conservative doctor, and don't believe that more is better - unlike a lot of "immune therpaists" in the field of IVF. To each his own

What was your uterine lining thickness ? A thin lining will definitely reduce the chances of implantation. How and why did you develop Asherman syndrome ?

Please remember the Serenity Prayer
God grant me the serenity to accept the things I cannot change;
the courage to change the things I can;
and the wisdom to know the difference.