Prior Unsuccessful Fertility Treatment

When you come to us after experiencing unsuccessful fertility treatment through IUI or IVF, we are dedicated to giving you the attention you need to achieve a healthy pregnancy.

First, we will review your prior records thoroughly to detect possible improvements in ovarian response to fertility medications, embryo quality, endometrium, and embryo transfer.

We may also order additional tests, such as:

• Karyotype for a chromosome analysis of both partners
• Saline sonography to detect any abnormalities in the uterine cavity
• Endometrial biopsy to detect inflammation of the lining of the uterus
• Endometrial receptivity array (ERA) to determine if the endometrial cavity is ready for embryo implantation
• Review of ultrasound and hysterosalpingogram (HSG) to detect a possible dilated fallopian tube (hydrosalpinx) that should be excised before treatment

We will then address any abnormality detected before initiating further treatment.

Your Treatment Options After Prior Unsuccessful Fertility Treatment

When working with you to develop your treatment plan, we will consider a number of interventions, depending upon your unique situation.

These may include:

• Modifying the stimulation protocol based on ovarian reserve. First, we will work to gain a thorough understanding of your ovarian reserve so that we can select the most suitable ovarian stimulation protocol to improve the number and quality of eggs for implantation. For women with low response to stimulation, we will consider a different stimulation method. Synchronization of the follicles prior to stimulation by preventing premature growth of follicles prior to the start of menses improves egg yield. Other possible changes include the dose of external medication, promoting internal FSH production and adding LH activity.
• For women with high ovarian reserves who are producing many eggs, but not achieving pregnancy even after the transfer of good quality embryos, we consider changing the stimulation protocol. This often helps to reduce the number of eggs produced, while increasing egg maturity and embryo quality. In vitro maturation is also considered.
• Reducing the dose of gonadotropins, combining them with oral medications (clomid, letrozole) or growth hormone. This may also improve the number and quality of oocytes produced.
• Changing the timing of trigger shot (hCG), which may also improve the quality of oocytes produced.
• Minimal stimulation, natural cycle IVF and In vitro maturation are also considered.
• Improving endometrial thickness and pattern and/or transferring embryos in a frozen cycle.
• Studying the direction and pathway of the cervical canal so that we can easily transfer embryos Performing genetic testing of the embryos. This approach may be feasible in women who are producing a moderate or large number of eggs and embryos, but still failing to achieve pregnancy or in cases where the woman or man has an abnormal chromosome configuration. Genetic testing enables selection of the chromosomally normal embryos for transfer.
• Use of gestational carrier: considered in women with abnormalities in the uterus that could not be corrected e.g Asherman syndrome (intrauterine adhesions)

If you had difficulty with prior fertility treatment please contact us to set up a consultation to discuss your unique situation.