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Infertility/Fertility/UAE and possibility of pregnancy


Hello Dr Ramirez,
First I want to thank you for providing this forum.
I am 41yo with h/o of Uterine Artery Embolization about 5 years ago due to a large fibroid heavy/painful menses and anemia. I also have a h/o premature ovarian failure, I don't ovulate or have natural cycles. I remember having hot flashes at about 36yo.
The UAE did very little to help my symptoms and now desiring pregnancy i underwent a laproscopic myometcomy last year where one 9 cm fibroid was removed. I have been following with an RE since 2013 and have been on a regimen on estrogen for 21days followed by 7 days of progesterone in an effort to keep my endometrium functioning and primed.
While following with my RE i would constantly have issues with 'uterine fluid" which actually turns out to be a mucous- like discharge. It seems closely related to estrogen intake.I would have some difficulty with my uterine lining. it has gotten as thick as 10mm at one time.
I have also undergone a saline sonogram which was normal.
We attempted a DE 5day transfer a few weeks ago and it resulted in a negative result. i was on a regimen of estrace, progesterone IM, prednisone 16mg for 5 days, and doxycycline for 5 days as well. My RE seems to think that there is some uterine damage on a molecular level which is causing issues with my endometrium. My question is do you think there is a place for the Endometrial fxn test/Endometrial Receptivity test or beta-integrins in my workup? these tests were never done or discussed in my workup. What is your prognosis in my ability to get pregnant and carry to term?
Thanks for your help!

Hello CEE from the U.S. (Delaware),

I don't think that one IVF cycle is sufficient to give any information or prognosis in your case because of your age.  At 41 years old, egg quality tends to be the issue and there is no technology to check this.  I realize that with your uterine history, it is suspect, but that would not be my main concern in your case.  Egg quality is the primary problem you are facing.  As such, I don' think that the endometrial tests you mention are of any benefit.  Besides, if they return abnormal, the treatment is progesterone at an increased dosage.  Why not just do that to cover the bases?  I think if you ask your doctor about the likelihood that age is the reason, I think he/she will concur that it is the primary problem.  

So, with all this said, I think you need to realize that because of egg quality, it is going to be harder for you to achieve success.  That means more attempts.  In subsequent cycles, you might want to consider doing PGS (preimplantation genetic screening) to help identify on the normal embryos before transfer.  Of course, the alternative if your eggs are not good enough, is to use donor eggs.

Good Luck.


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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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