Infertility/Fertility/Donor cycle


Dear Ramirez
I am 42 years old and have been undergoing fertility treatment for a number of years in Ireland. After much testing which for me included a laperscopy, they found everything normal. My husband had anti sperm and all samples had poor mobility. We did the DNA fragment test and the results were very good. We were advised to have IVF with ICSI. Our first IVF was cancelled as I did not respond (at the time I was 39). They changed protocol, my second IVF we also cancelled as my response was worse than the first one. My third and fourth IVF went ahead and I had around seven eggs with 5 fertilising and 3 put back none were frozen. I never had an eight cell embryo they were four,  six and ten cell. Both IVF failed. I was advised to go the donor egg route.

My donor cycle we collected 18 egg 15 fertilised all 8 cell, 12 made it to day 3 and I put 3 back. The result was a twin pregnancy, which was the best time of my life until I lost the twins at 24 weeks. There was no explanation, they were perfect it was assumed my cervix shortened. I then had two more FET both failed. Which brings me to today and my predicament.

Also I did further testing for immune blood such as NK cell etc, all came back clear. I had a hysterscopy in August which came back clear. After the hysterscopy I did not have a period for 3 months. I had a scan which revealed a cyst. I took progestrone for 5 days once cyst was gone and I had a period followed two weeks later by another period. I have never missed a period since they started when I was 13. I have a regular cycle every 28 days. I would consider myself healthy, active and I am not overweight. I had regular scans since August and my uterus lining was 5mm then 6mm and finally back up to 8mm. All my IVF including the transfer for the twins my lining was 8mm always tripled lined. The frozen cycles my lining reached 10mm.

I am currently undergoing my second fresh donor cycle, I was put on a higher dose of estrogen to thicken my lining I also am taking baby asprin and Viagra. I had lining scan day 10 and it was 7mm I was really happy with that as it was the same at day 10 for my twin pregnancy. We had egg collection on the 26th Dec they collected 11 eggs. I did a scan and my lining is the  same 7mm. I'm devastated, they still want to go ahead as its a fresh cycle but are asking me to transfer 3 as my lining is so thin so it will increase my chances. I don't understand why I am having lining issues now and if I transfer 3 there is a small chance of multiply pregnancy which is impossible for me. They spoke about a reduction if two or more stuck. I have my transfer tomorrow and I am so upset. It's like the universe is against me.

My question is why am I having lining problems. Is 7mm too thin. Am I crazy to even consider putting 3 embryos back in tomorrow
Thanking you in advance


I'm sorry I can't answer your main question about the lining because there is no answer for it and no way to find out.  Generally lining thickness is dependent on the estrogen dosage.  You don't mention how much estrogen you are taking and what route you are taking it.  Orally is the most ineffective way and not recommended.  It is recommended to take it either as a patch, injection or vaginal suppository. If the lining is not thick enough, then the amount of estrogen needs to be increased.  Other options include adding low dose aspirin and heparin or lovenox to increase blood flow, at the microvascular level, to the lining/implantation site.

If the lining is not thick enough, I use a baseline of 9 mm in my practice but studies have shown that it can be as low as 7 mms, I would not recommend proceeding with the transfer because the embryos would be wasted.  It doesn't matter how many are transferred.  I would recommend freezing the embryos and only transferring in a cycle where the lining was thick enough.

One thing to keep in mind is that you did achieve a pregnancy with IVF in the past.  IVF technology can only give you the opportunity to become pregnant, it does not insure a successful pregnancy.  That part is fully dependent on the pregnancy itself.  It sounds like you had premature labor and delivered before the fetus' were viable.  It's too bad because they probably only needed 2-4 more weeks to be survivable.  But keep in mind that you were able to make it and so it can work again.  In the next pregnancy you will need to be monitored more closely.

Good Luck,

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

Monterey, California, U.S.A.

for additional information check out my blog at check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate


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Edward Joseph Ramirez, MD, FACOG


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.


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 19 years.

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

American Journal of Obstetrics and Gynecology, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

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

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