Infertility/Fertility/RIF autoimmune


I am 31 and have had 5 IVF failures due to lack of implantation.
I have autoimmune issues like ATA(hashimotos), Rheumatoid athritis(initial phase, since August 2012), Endometrioma(removed).
I have had every other test which came out normal.
Embryos transferred were of good quality.
I am a partial DQalpha match(alloimmune?) with my husband.

Around the time of implantation I have noticed fever and sometimes joint pain(which seems to be RA trigger).
I had a natural preg in between the IVFs which got miscarried at 2nd month.
Last year, clipped the tubes due to hydrosalpinx.

Are the failures immune related and what else can be done to get success as we are reaching the dead end?

How important is clean room Air system in pregnancy rates?

Thnx doc

Hello Ria from India,

Certainly the immune system plays a role in implantation so could be part of the problem.  Hydrosalpinges, wich you just removed last year, can also play a role.  The presence of a hydrosalpinx has been shown to decrease pregnancy rates by 50%.  So the question is, how many of your IVF cycle were before the hydrosalpinx was removed.  The answer to that question might or might not increase the chances of your immune issues playing a role.

I cannot tell you specifically what to do since you are not my patient.  However, I can state that immune disorders are one of the top causes of recurrent pregnancy loss, and therefore IVF failures a well.  There are well documented protocols to use in those cases.  You might want to discuss these options with our current reproductive specialist, or find someone who is well versed in these treatments before you proceed with another IVF cycle.

The air system within the embryology laboratory has been shown to influence the development of embryos and therefore, the pregnancy rates.  It is a very important part of a top level IVF center and program.

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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