Actually, we were thinking of doing the 2nd IVF at the same place (Columbia). I liked my RE and thought that it is best to work with the same doctor since she (hopefully) learned something from my first cycle. We were happy after the consultation with her. However, since we had to wait 2 months between IVFs (my RE wanted to do SIS to make sure I do not have polyps). Since we had to wait, I wanted to do as many tests as I can to rule out some other issues. I did not want to go through several IVFs just to find out some sort of immune issue that was not addressed. But Columbia RE said they do not test for immune issues (or anything else that I was not tested for already). I did not even know about SIRM, when I found them on the web when I was searching for doctors doing reproductive immunology screening. I wanted to schedule an appointment with Dr. T, but he was on vacation and I did not want to wait so we went with Dr. Wang.
He went over all possible reasons why my 1st IVF might have failed and discussed the tests he would recommend. After the appointment it was obvious for us that we have to switch REs. I am so glad we did! I had such a better experience. What I liked about Dr. Wang is that he explained the reason for every drug/ dose and remembered every little detail about our case. He seems to be very skilled as well. My transfer with him was very easy, while most of my IUIs and the IVF at Columbia were a torture (my cervix has a difficult tilt).
Here is a summary of the reasons why my 1st IVF might have not worked according to Dr. Wang.
50% bad luck
Potential issue with implantation. Additional tests:[/LIST] [LIST][LIST]
Natural killer cells
TH1/TH2 Cytokine ratio. If elevated, my body could be killing embryos
HLA genotype panel (HLA A, B, C, DR, DQa, DQB) (test if my genes and DH’s genes are too similar. If so, my body might be rejecting embryo. Not sure what the solution is – suppressing immune system?)
[*]DNA fragmentation in sperm (even a very good looking embryo might not be so good if DNA fragmentation in the sperm is high)[/LIST][/LIST] i. If high, we can do PICSI (Pre-selected ICSI). Pick the sperm that binds to some acid. PICSI is as successful as ICSI if there is little DNA fragmentation.
Progesterone issues (period started a day before beta, spotting started 3 days before beta)[/LIST] [LIST][LIST]
Since my period started before beta (11p3dt) and while on progesterone, there is a chance my progesterone was not sufficient. Solution – do shots rather than vaginal capsules. Old RE said having period early is not a big problem and that if I want, I can take two rather than one capsule of progesterone.
[*]Another issue – high progesterone at ER. If so, implantation window is shifted (ends sooner). Then embryos do not have enough time to implant. I wonder if this was my issue. My luteal phase is always very long (15-17 days) and is very regular. Solution – monitor progesterone and do not do transfer if progesterone is too high (perform FET). More specifically, if progesterone is >1.5 on the day of ER (happens to 1 out of four women), do not transfer.[/LIST][/LIST] It turns out all the tests came back normal (except for some from Thrombophilia panel – see signature – but Dr. Wang said those were not a huge deal). I think the main reasons for my first IVF not working could have been that my follicles were too big at trigger and probably my progesterone was too high. Inadequate progesterone support could have also played a role.
I would definitely do a consultation with a new RE. I think you will know what the right decision is for you after it.
GOOD LUCK! I hope you will get your BFP very soon.