Infertility/Fertility/Thin lining concerns


My husband got pregnant in July of 2012. After miscarrying I had D & C. Due to retained product I ended up in the hospital for a 2nd D & C. They used a sonogram machine to make sure they didn't take to much and to prevent Ashermans. After a year of not getting pregnant and light periods (2 days and very little blood) and approaching 37we saw an RE. We did all the tests, HSG, hysterscopy, water sono....all looked good. My doctor said I had minimal scarring. He placed a ballon in after my surgery and put me on estrogen, my lining improved to an 8 and I had a normal period. After that we tried IVF. I took Gonal F 150 in the morning in 225 at night. After 5 days they added a vial of menopur. I stemmed for 14 lining was close to a 6 and we only retrieved for eggs despite my AMH levels being over a 3.  We put back 3 of the 4 on a three day transfer - two were six cell and 1 was four. One of the six cells was pretty fragmented. It didn't work. My husband and I are really unsure if we should try again. My RE indicated I was on very high doses of drugs and responded poorly to the stemming process - which could happen again. I am more concerned with my lining and my continual light periods. He did mention I still have the triple layer in my lining. I really want to have my own child. I am very healthy, work out 5 days a week, eat a gluten free diet and am working hard to find answers. Any help would be appreciated.

Hello Rae from the U.S. (Kansas),

First, I don't think you should give up.  Doing one IVF cycle is the same has having intercourse only in one month when trying to get pregnant.  Would that work?  Probably not.  Most women need to have intercourse monthly for an average of 8 months to get pregnant.  So, if you were trying naturally, would you just try only one month and then call it quits for the rest of your life?  IVF reproduces the reproductive cycle up to a certain point.  It is not 100% successful.  It still can take multiple tries to get pregnant, just as it would naturally.  Just not as many.

Second, the most likely reason for your failure was poor embryo quality.  By D#3, the ideal embryos are 7-8 cells, grade I.  Your best embryo was a six cell; not that great.  The quality of eggs is directly affected by the age of the eggs i.e. 37 years old.  As you know a woman's chance of pregnancy, her fertility, decreases as she gets older and that is because the quality of the eggs declines with age.

Finally, you used a total of 375IU of FSH initially and then added another 75IU for a total dosage of 450IU.  That is a higher dose but not the highest doses.  The highest doses are up to 600IU and usually split as 450IU FSH (Gonal-f) and 150IU FSH+LH (Menopur).

My recommendation is if you want it bad enough, don't give up!  Every cycle is different, recruits new eggs and thus the outcome may be completely different.  With age, the goal is to try to find one of the remaining good eggs in your ovary.  The only way to do that is to keep going through the eggs.

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.  I now provide personalized fee for service consultations/advice/direction via email and payable via Pay Pal.  If interested, contact me via my email at  This service will allow you to have your own personal on-demand infertility expert


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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, California Medical Association, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists

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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