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Infertility/Fertility/Endo lining thin due to d/c?

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Hi,
I've been seeing a fertility specialist on and off for about 4 years. I have two children; my older son I conceived naturally, but I did take Clomid, at the age of 30. My second one, I did IVF at 34, it worked on the first shot and had a healthy pregnancy. However,I was diagnosed with a complete previa at 19 weeks and had a hemorrhage at 36.5 weeks. Despite this, I delivered a healthy baby. Since my second son was born, I have been pregnant 4 times, once naturally, the others were a combination of frozen embryo transfers (from my son's cycle) and a fresh IVF. My most recent IVF was last year, and I was 38. I still have frozen 5-day blasts from that cycle. All of the pregnancies ended in m/c, the latest one being at 15 weeks due to tri 21 and water on the brain. The first pregnancy, the dr only saw an empty sac, the second was tested (after the d/c) and came back as normal, the third was tri 21, and my last one (a couple of months ago) was expelled naturally. This one threw us all for a loop, since my numbers were rising normally. All of my tests came back normal, except two things. My protein c is slightly elevated and most recently my uterine lining has always been thin.
I have been on estrogen patches and estrogen suppositories. My question is, could the three d/cs I have had caused permanent damage to my uterus? I have not had any other uterine procedures/issues. I am 39 and almost ready to throw in the towel, but I do have 4 remaining blasts and it kind of bothers me to not use them. Thanks for your time.

Answer
Hello Lee fromt the U.S. (Arizona),

Your question is open ended so the answer has to  include all possibilities, which is yes, the D&C's could have caused an in-hospitable endometrium.  However, in most cases of scar tissue formation resulting from repeat D&C's, implantation usually does not occur.  Therefore, I don't think that this is the proximal reason for the miscarriages.  Your age is still the number one reason for miscarriage, which can be as high as 50% per cycle after the age of 35.  These are due to spontaneous genetic abnormalities caused during the division of the embryo.  Trisomy 21 is one example but it is a mild abnormality.  Most are multiple abnormalities and not compatible with life.

Uterine lining thickness is critical for implantation and continuation of the pregnancy.  It sounds like you have a competent RE and he/she is doing the appropriate things.  I would just recommend that when doing the FET's, you do not transfer until or unless the lining is at least 9 mms.  With FET's timing is not an issue and you can continue with the estrogen supplementation as long as it takes to get ready.  The timing does not become critical until the progesterone starts so we just withhold the progesterone until the lining is appropriate size.

One final bit of advice.  Don't give up.  As long as you try, you have a chance to be successful.  If you stop, you won't.  If worst comes to worst, you can always consider a surrogate, but I don't think that is necessary.  Remember age is the factor and what you are trying to do is find the perfect egg.  Hopefully, there are still some left in your uterus.  Despite the fact that you got pregnant easily the previous time, that is not an automatic thing so approach the cycles with a little more reservation, don't expect to be successful; just hope to be.

Good Luck,

Dr. 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 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

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 19 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, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

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

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