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What are the Options for Women with Multiple Failed Cycles?
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Ask The Experts
What are the options for women with multiple failed cycles?
Dr. Bruce Shapiro, The Fertility Center of Las Vegas: When a woman has had multiple failed cycles we have to consider two possibilities.
One: that there was abnormal embryo endometrial synchrony.
So that the embryo, when it was placed into the uterus, was not in synchrony with the lining of the uterus.
The lining of the uterus has to be ready when the embryo's ready to implant.
If the endometrium, the lining of the uterus, isn't ready for implantation, even though you put in a perfectly good embryo it won't be able to attach.
The other thing that could go wrong is that the embryo itself. Sometimes an embryo can make it into the uterus and its chromosome
will be abnormal or it can be morphologically abnormal as well.
So when any of these things occur the likelihood that the embryo is going to implant will be decreased
even in the presence of a perfectly timed implantation with a uterus that is receptive and ready to receive the embryo.
So, again, the two things that we need to be concerned about are: one, whether there's good embryo endometrial synchrony
and the other thing is whether or not it's a good embryo that's being placed into the uterus.
So when a woman that presents with a history of failed IVF when we consider these two things,
what we want to do is try to eliminate them as variables.
So the first thing we want to do is not do a fresh cycle; we do want to do a frozen cycle.
So we want to take the embryos out, fertilize them and either freeze them right away after fertilization
or wait till they develop to the blastocyst stage and then freeze them.
And then in the next cycle we can time the endometrium so that when we thaw the embryos
they'll be in perfect synchrony with the lining of the uterus.
And that eliminates the possibility that it's an endometrial problem.
At the same time, in older patients, we want to make sure that the embryo's a good quality so we can couple this thaw cycle with embryo biopsy
and do pre-implantation genetic screening to make sure that the embryo is normal in terms of the number of chromosomes that it has.
When we have both of these two things that are present, the likelihood of implantation is going to be greatly increased.
In our studies we found just by placing patients into a frozen thaw cycle, after they've had failure in a fresh cycle,
we've been able to get a large percentage of those patients pregnant.
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