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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 > ivf failure

Infertility/Fertility - ivf failure

Expert: Edward Joseph Ramirez, MD, FACOG - 11/4/2009

Question
Hi Dr. Ramirez, I am Asian, age 33, menarche at age 11, and we have gone through three failed IUI attempts and just had our first course of IVF. I went through the lupron/gonal-f 225-375iu/novarel protocol, though I am not certain of the dosages. 10 follicles were retrieved, but required about 2 weeks of gonal-f stimulation in escalating doses.

Half of the eggs were used in icsi, and half for natural fertilization but we discovered that only 2/5 icsi eggs were healthy enough for icsi attempts and both ultimately failed to fertilize & develop. 3/5 natural fertilization eggs had some successful fertilization but after 2 days of growth, all three arrested at day 3 with excessive fragmentation at or prior to 2 cell stage.

My husband is a 33 years old asian, in good health, as I am, and we do not understand why "the quality" of my eggs was poor as we have been told thus far. Do you have any advice/ thoughts for us? Do you think that my "early" menarche had any role in causing this? And, how does acupunture help in this situation in your experience? Thank you very much.

Answer
Hello Ting from the U.S.,

I have to admit that I am a little skeptical of your results. Based on your age, you should have had a much better outcome. Something doesn't fit here.

I don't know why your clinic split your eggs into ICSI and natural. You should go with one or the other. I do ICSI on the majority of my patients, but that is an individual choice. It is possible, and most likely, that the reason the ICSI eggs could not be fertilized was because they were immature. An embryologist can only look for maturity of eggs if ICSI is going to be done because they need to strip the outer membrane. Only mature eggs can be injected. It is possible that the low fertilization in the "natural" side also was because of a low number of mature eggs. If that is the case, it would mean that you were retrieved too early, and not necessarily because of an egg problem.

You were also on a low-dose stimulation protocol, which will affect the number of follicles recruited and the number of eggs retrieved. Hopefully, in your next cycle, the doctor will make adjustments in your protocol to stimulate you better, now that they know how you react, so that you will have more eggs to work with. I would also recommend that you consider doing ICSI with all your eggs the next time.

Finally, I think you need to have this discussion with your doctor regarding these issues as well. Make sure, he/she is doing the right thing. Outcomes are very closely tied to the clinic that you go to. Based on your age, there is no reason why your egg quality should be inhibited.

Sincerely,

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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