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About Edward Joseph Ramirez, MD, FACOG
Expertise
I am a specialist in infertility and advanced gynecological care. I can answer questions about infertility, gynecology related ills, menopause...virtually anything that affects women's health. PLEASE tell me where you are writing from as I am always interested.

Experience
I have been practicing as an Ob/Gyn and Infertility Specialist for over 23 years. Gynecology, advanced laparoscopic surgery, basic infertility, IUI's, IVF, reproductive surgery, and ovulation induction are all areas of my expertise. I am Board Certified. I have been doing In Vitro Fertilization in my clinic for 15 years.

Organizations
American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, Society of Assisted Reproductive Technology, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists,Resolve-National Chapter, Open Path - Northern California, Board of Directors Monterey Medical Society

Publications
American Journal of Obstetrics and Gynecology

Education/Credentials
Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco

You are here: Experts > Health/Fitness > Women's Health > Infertility/Fertility > Failed IVF

Infertility/Fertility - Failed IVF

Expert: Edward Joseph Ramirez, MD, FACOG - 10/26/2009

Question
Hello Dr. Ramirez,

I just found out today that my first IVF failed. 5 eggs were retrieved, 4 fertilized, all grade A. We transferred 2 Grade A 8-cell on day 3. I now have two frozen. I am very shocked and upset that this IVF didn't work. A little background on me:
Secondary infertility-son conceived naturally 1st month
Unexplained infertility
31 years old-FSH 6.1
What causes a failure of the embryos to implant?
I have never had laporascopy and I'm wondering if I should do that before a Frozen Embryo Transfer?
I had a saline ultrasound last winter and my RE said that there was a "slight irregularity" in the uterine lining. He said that it could possibly be polyps, but nothing that is significant enough. He didn't think that it was the cause of my infertility. Could this cause implantation failure? If so, would laproscopy identify and treat this?
Also, I had 7 follicles before retrieval. During retrieval the doctor said that it looked like I may have ovulated from 1-2 follicles. He said something about fluid and extracted it, thinking he might find an egg. Why would I have ovulated early when I was on Lupron (10units and then down to 5 units for stimulation)?
What would you recommend next? FET? Laprascopy? Should I take a few months break to let my body rest? Do you do natural or medicated Frozen cycles? Is one proven to be more effective than the other?
I know I have a lot of questions and really appreciate you answering them! I want to be an informed patient when I have a follow-up consult with the RE. I would like to go to another clinic for a second opinion, but unfortunately, we only have insurance for this RE clinic.
Oh, I'm from Ohio. Thank you!

Answer
Hello Kristen from the U.S.,

Let me answer your question sequentially:

1. Implantation failure can occur from either an embryo problem or a uterine problem. We don't exactly which may have occurred and there is no way to test for this. Implantation is a very complex process that requires both the embryo and the uterine lining to work synergistically. However, failure of embryos to implant do not necessarily mean that there was implantation failure, although we use this to mean anything that causes failure after good embryos were transferred. Transfer technique and quality can also lead to implantation failure if the endometrial was disturbed by to aggressive a transfer technique. Finally, keep in mind that even in the best hands, with the best transfer technique and best embryos, IVF still fails for unknown reasons. I attribute that to the fact that the last two steps, hatching and implantation, are still "natural" steps that we don't have the technology to control.

2. A laparoscopy is not indicated and does nothing to help your pregnancy rates at this point.

3. Your doctor may want to do a hysteroscopy to review the endometrial cavity in more detail. Saline sonohysterograms are still not very specific or sensitive. Laparoscopy looks at the outside only. Again, this would not be of any benefits if you are doing IVF.

4. If you ovulated early, that could certainly affect the likelihood of success because there is a very short window of opportunity for implantation. If things occurred earlier than expected, then the window is shifted and implantation timing would be affected. Lupron does not guarantee that ovulation would not occur. The ovary sometimes has its own mind and schedule.

5. If you have frozen embryos, then it is worthwhile to given them a try. It is a much easier and less expensive procedure. Just keep in mind that FET pregnancy rates are about 1/2 of fresh embryo rates. I do not do natural cycle FET's because the cycle cannot be adequately controlled and offer no benefit. You do not need to take a rest, other than one month off, unless emotionally you feel you need the break.

6. In general, pregnancy rates for your age group are 50-60%, which means that 40-50% fail. In addition, in my clinic, 60% get pregnant on their first try, which also means than 40% have to try 2-3 times. IVF is not a perfect technology. We are only assisting the bodies natural processes. We cannot control all of them. So despite the fact that you did not get pregnant in the first cycle, that does not mean that you won't get pregnant, and does not mean that the doctor did something wrong. You have to keep trying because that is the way it is in nature. Most women under 30 years old take 8-12 months to get pregnant naturally. IVF is better because we are accomplishing more of the process to get pregnant, but it is still not perfect. Most patients (86%) will take up to three tries to get pregnant. Keep trying. You are the perfect candidate for IVF (most clinics want more patients like you) and have the highest chances for success. You just have to hang in there.

Good Luck,

Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com

Monterey, California, U.S.A.

for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on facebook and twitter with me at @montereybayivf

Good Luck,

Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com

Monterey, California, U.S.A.

for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on facebook and twitter with me at @montereybayivf

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