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I went to SIRM in Las Vegas

February 24 2011 at 1:14 PM
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Response to SIRM an ok replacement if I cant find repro immune doc?

Dr. Sher was my doctor very early in my journey and I was pleased that he was very thorough in his workup and most importantly, he listened to me. Of course I have no idea about Dr. Saleh but would imagine he would follow Dr. Sher's basic philosophies. Unfortunately shortly after seeing Dr. Sher (and not having success with my own eggs) I developed further problems with my uterus that went undiagnosed for years. I don't blame Dr. Sher for not picking up on something that didn't exist at the time I was his patient, but I'm pretty angry at all the REs I saw after him that failed abysmally.

As someone who failed at DE with multiple donors and multiple transfers, I cannot emphasize enough how important it is that you rule out other issues in yourself or your husband before moving to DE. It took 9 years and multiple REs before anyone figured out that my problem was really my endometrial lining. I had Asherman's from all my miscarriages. By then, my eggs were crap so I ended up with DE and GS (gestational surrogacy).

It is extremely important in my opinion that you insist upon a karyotype for both you and your husband, to rule out something like a balanced translocation, which can be present in your husband even if the sperm looks totally normal. It will cause multiple miscarriage when everything appears to be normal. Sometimes it is treatable in the sense that preimplantation genetic diagnosis can be done on embryos obtained from IVF. You'd hate to spend 30K on a DE cycle only to find out that your hubby has a BT and you could never have a normal pregnancy unless a normal embryo was put back. It's a blood test that costs a few hundred dollars and will take a few weeks to return results, but it is so worth it. I have a real life friend as well as a couple of cyber buddies who had a balanced translocation and it took YEARS for the REs to figure out "Doh! maybe we should run a karyotype."

I would also look at sperm DNA fragmentation, or SCSA. This is a problem that is more common in men over 40 so may not be an issue with your DH depending upon how old he is. But again, it can be present even when the semen analysis is within normal limits.

I wish that we could have just taken every darned test known to man (it would have saved us money in the long run) but the RE will take a history and then based upon the likelihood of a problem being present will order only certain tests but not others.

If you want to test whether it's your eggs or not, you could do an IVF cycle, and then do CGH (comparative genomic hybridization) on every embryo. CGH is superior to the traditional PGD because it tests for ALL chromosome pairs, whereas PGD only tests for a few, leaving the field wide open for "normal" embryos to actually have chromosomal abnormalities in other untested chromosome pairs. If you do CGH and a high percentage of embryos come back with a chromosomal problem, then you know that it is your egg quality at fault. If you get some normal embryos, truly normal because CGH tests all chromosomes, then you know you are putting back an embryo that should have a good chance of implanting. If it doesn't, could still be just the luck of the draw, or could point to a uterine problem.

If you have had several miscarriages, you need an HSG (hystosalpingogram) or a hysteroscopy (preferred) to see if you have any scar tissue that may be creating a poor environment and contributing to the miscarriages.

The way it has been explained to me is this -- if a miscarriage occurs before 8 weeks, it is most often due to chromosomal abnormality or genetic problems (such as a BT). If it occurs after that, it is most often due to hormonal deficiency or poor blood supply to the endometrium.

If you never had implantation at all, then you'd want to look at endometrial problems like being out of phase. But since you get implantation, that's unlikely to be the problem.

If you had been followed by an RE during these pregnancies, you would have more data to go on because they will typically do an u/s at 5 weeks or 6 weeks. You'd know then if the sac and embryo looked normal, had a heartbeat, measured normally, etc and that would be extra information.

It sounds to me like your RE is a typical lazy f@ck who just wants to blame the problem on your eggs without doing his due diligence. I've met many REs like that and that's how we ended up spending 150K on multiple DE cycles that could never have worked because the REAL problem was undiagnosed.

Good luck!

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