What prevents a chromosomally normal embryo from implanting ?

The most common reason for a failed IVF is , the embryo ( s ) that are transferred to the uterus are chromosomally abnormal  ( contain wrong number of chromosomes ) ,  and this genetic defect prevents them from implantating , and/or giving rise to a healthy baby ( since the blue print for forming a baby is defective ) . With modern scientific advancements it is possible to test whether an embryo is genetically normal or not by using techniques like Comprehensive Chromosome Screening ( CCS ). So , when a chromosomally normal embryo ( an embryo which has the correct number of chromosomes )  is transferred to the uterus , patients expect to get pregnant and carry the baby to term. But , the reality is not so. 

Why does a chromosomally normal embryo fail to give rise to a healthy pregnancy ? The reasons are manifold :

1. Not all genetic testings , including CCS , are 100% accurate. They claim that the accuracy of these techniques is close to 99%.
2. Many blastocyst exhibit a phenomenon called embryonic mosaicism. During biopsy of the embryo , 5 - 10 cells from the trophoectoderm of the blastocyst ( the region which becomes future placenta ) are removed and tested for chromosomal abnormalities. Even though , the cells taken from the trophoectoderm of the embryo can have a normal chromosomal number , the inner cell mass which develops into the baby can actually carry wrong number of chromosomes. Hence , because of embryonic mosaicism , a chromosomally abnormal embryo can be labelled as chromosomally normal , and can be transferred to the uterus. Such embryos might fail to implant. Because of embryonic mosaicism there is also the danger of discarding a chromosomally normal embryo as abnormal. 

3. Damage to the embryos during biopsy can lead to failed implantation.

4. Transfer of embryo to the uterus , and depositing them at the optimal location needs a lot of skill and expertise.  When an embryo transfer was not done by a skilled doctor , the embryo might lose its chance to implant. The transferred embryo must also be retained in the optimal location. A stressful embryo transfer due cervical stenosis , or other such problems can trigger uterus contractions which can dislocate the embryo.

5.  The embryo must be transferred to the endometrium when it is optimally receptive. The " window of receptivity " of an endometrium is very short. Although , most embryo transfers are optimally timed , the high amount of hormones present during fresh IVF transfer can tamper with the normal time period when an endometrium is optimally receptive ( it can become receptive too soon ! ) .This can lead to the transfer of embryo to an endometrum which is not synchronized with the embryo's age.  This in turn can lead to failed implantation.

6. An embryo being chromosomslly normal does not guarantee that it is normal at the gene level.  For example , humans carry approximately 20 , 000 plus genes in their chromosomes.  Embryo implantation and growth  involves the complex interplay of many different genes - many of which are still not identified ! Defects in such genes can prevent an embryo from implanting. We simply do not have the technology to identify them.

6. An IVF lab's embryo culture conditions , the medium used , their embryo handling and manipulation techniques can lead to failed implantation. Hence , selecting an IVF lab with good success rate is highly beneficial.

8. Mitochondria are organelles which are present in large numbers in eggs and embryos. They are the power house of cells and perform many other critical functions. They carry their own genetic material. Research shows that defect in their genetic material can prevent implantation. Older women's eggs are more prone to mitochondrial defects. We still do not have the technology to screen them.
9. Many proteins and their metabolites interplay at the site of embryo - endometrial contact to bring on a successful implantation. Defects in those molecules , or in their molecular interaction can lead to failed implantation.

In short , transferring a chromosomally normal embryo doesn't guarantee a pregnancy. An euploid embryo of an younger woman is more likely to implant than that of an older woman ( this indicates that there are many other factors at play other than the presence of normal number of chromosomes ) . 

If you need to talk to me , please write to msnjupadmasekar@yahoo.com

What secondary infertility does to you ?

" Well this month also I have not conceived as I got my periods today:-) Not sure how to react. reading your blog has given me strength and I think I should  be thankful to God that he has anyway blessed me. I know there are so many women fighting Infertility bravely.

I am so blessed that when I go home I can hold my daughter close to me and I feel solace when she call me Mamma. At times I tell her call me Mamma again and again and I feel so happy. I know I am sounding absurd but I know the importance now , for which I never valued.

I really feel I am still fortunate, yes I wanted to have 2 kids and when I started I never knew this would come so long and I will  face issues.

Thanks for making so many people feel better and happy. Love to you and Anisha.  Anisha's smile is therapeutic. God bless her truly."

If you need to talk to me , please write to manjupadmasekar@yahoo.com

Endogel to clear endometriosis tissue in uterus !

Questions # 3

Hope you and your baby are fine,I have been reading your postings on IVF so encouraging,I have had three fa

iled cycles,am now preparing for the forth one,my doctor told me I have endometriosis tissues in my uterus,that has been made it impossible for my babies to implant,so I was given Endogel to have them cleared,can this increase the chances of becoming pregnant,am so depressed I surely don't know what to expect next.....               

both my tubes are blocked that's why I opted for IVF am turning 37 years this year, first cycle I had 15 eggs13 fertilized, en two were put back, my lining was 12mm, the second cycle were frozen embryo 2, en the third one was the the fresh one, I only had 4 embryos due to some problems with the last injection that helps the the eggs to mature, it was given very late after the due time, so only one develop en it was a grade A, so I have decided to change the doctor...so I did hysteroscopy with him and he found that I had some tissus in the uterus, so they had to cut them, then the following day I went in for Endogel, in the night I developed serious running stomach just for few minutes, there after I started my periods, they were so heavy for 8 days same flow, after periods I had some creamish discharge for almost  one month,en now everything has become normal and my vaginal discharge is 100% normal, now I have even started ovulating before I never used to........  I actually paid $1000 for the Endogel

Answer :

I have come across this Endo Gel query many a time now ( especially from many African women ! ) I don't understand how Endo Gel can dissolve endometriosis tissue in the uterus ! I feel so sorry for women who are taken for a ride by their IVF doctor. An IVF doctor is a person whom patients trust and handover the responsibility of making their most desired baby dream come true. I feel disgusted when such doctors use their patients' ignorance to make money. It is the utmost responsibility of every IVF patient to read and keep themselves well -informed about infertility treatments , if not , they are in danger of losing their money , health and eventually their baby dream , too.

Let me explain : Endometrium is the tissue that grows in your uterine cavity -  it is the lining of the uterus where your embryo implants. Imagine it as a bedding for your embryo. Endometriosis is a disease where your uterus lining ( endometrium ) grows in places where it is not meant to grow. For example , it can grow in your pelvic cavity , in the organs present in  pelvic cavity , and even in the brain ( very rarely ) . Endometriosis of uterus , that is , when endometrium that lines the uterine cavity grows into the muscular wall of the uterus it is called adenomyosis. Adenomyosis may or may not cause infertility.

Endo Gel is a derivative of hyaluronic acid In surgical medicine , it is used to prevent  adhesion from forming between different tissues or organs.  For example , if you are having a surgery to remove emdometriosis tissue grown in your pelvic region , there is a possibility that the surgery can itself lead to the formation of new adhesions between your pelvic organs during wound healing.  In order to prevent them from adhering to each other ( to stick to each other ) , Endo Gel is applied immediately after surgery.

Endo Gel cannot dissolve endometriosis tissue - it is used to prevent de novo adhesions from forming after abdomino - pelvic surgeries.

As per the above email , the doctor has performed hysteroscopy and done some surgical procedure on her uterus. The next day , he had applied endogel and informed her that the gel will dissolve endometriosis tissue in her uterus. Because of the rhyming between the words endometriosis and endogel , the poor patient believes that endogel will dissolve her endometriosis and all will be well soon ,  so that she can conceive. She had paid a hefty fee for the same - how sad !

This is exactly why  patients must stay well - informed about their treatment. Please stop believing all that your doctor says , blindly !  Seek second opinion ( or multiple opinions ) whenever you are asked to do costly tests , or before undergoing any invasive surgical therapy. Hysteroscopy can actually do much harm when done without any proper indication - it can even damage your uterus , permanently !

If you want to win over infertility , the first thing one had to do is to seek knowledge. Knowledge is power !

Please read the disclaimer at the top right corner of this blog !

If you need to talk to me , you can write to manjupadmasekar@yahoo.com

Is there a vitamin alternative to laser hatching of Zona pellucida ?

Question # 2

i'm doing an IUI in two days & wanted to know if there is an oral supplement or vitamin or food that will help in naturally thinning (or making less rigid) the outer zona pellucida.  i'm 48 yrs old & want to combat the more rigid ZP that older women have...

i had one IVF last year with assisted hatching (5 eggs retrieved... 4 were viable.... 3 were fertilized & those 3 embryos were implanted) ...but it failed

because i only have two mature follicles this time, my doctor wants to do an IUI, so i was hoping that i could take an oral supplement or vitamin or food that would thin or soften the outer layer of the zona pellucida (because it's probably more rigid since i'm 48 years old) since laser-hatching is not an option.

i don't have children because i'm the youngest of 9 children so my parents were both elderly when i was born & i had to take care of them after they had strokes (they both had high blood pressure) & so i delayed having children.  my boyfriend & i have tried to conceive over the past two years but without success.  hopefully this upcoming IUI will be successful.

Answer : 

Unfortunately , nothing can be done to reverse the aging of your eggs - you cannot thin it's outer covering with any vitamins.

I wish you lots of good luck. That's so nice of you to put your parents' needs first and supporting them. I love your optimism , and may your wish get fulfilled soon.

Although , I answered carefully in a way which doesn't hurt her hope and optimism , I felt guilty for not telling her the truth.

The chance of her getting pregnant and having a healthy baby with her own eggs is almost close to zero. I am sure she is aware of the scientific statistics , yet , she is trying her level best to fight the odds. Women like her amaze me. I wonder what I would have done if I were in her shoes !  What's the right move for a woman in her situation ? Should they move on to donor eggs , or try conceiving with their own eggs - until they produce eggs and embryos ?

According to scientific data , women after the age of 42 , have only 5 % chance ( perhaps , even less ! ) of taking home a healthy baby. After 45 , the chance of having a healthy baby with their own eggs is almost nil. Even though they produce eggs ,  the chance that all their eggs are genetically abnormal is extremely high.

Reference : https://www.ncbi.nlm.nih.gov/pubmed/25017405

But , what if ,  a woman after 45 years old luckily finds that one good embryo which will become her much desired baby ? Such happenings are not unheard of . Please read this article : https://www.ncbi.nlm.nih.gov/pubmed/26327892

This is exactly why  you must trust your gut feeling when deciding whether to continue IVF with your own eggs or to call it quits. Apart from considering financial , physical and emotional discomforts , please listen to your gut feeling too and decide for yourself.

But , if someone asks my opinion , as a biologist , as a person who values scientific evidence , I would say it is insane to continue with your own eggs if you are above 45 years. But , always remember , that there are a lucky few who have beat all the odds ! If your gut feeling says you could be one too , give IVF with your own eggs a few tries.

Please read the disclaimer at the top right corner of this blog !

If you need to talk to me , write to me to manjupadmasekar@yahoo.com

Can a high white blood cell count prevent embryo implantation ?

Question # 1

Would a high white blood count of 13500 stop implantation.  No symptoms of being sick however my wbc has been high for months.  I have ulcerative colitis but take humira and have no current symptoms.  I have three failed ivf attempts and one failed donor egg cycle all bfn

Answer :

My very confident answer is 'No'. 

Uterus lining , where the embryo implants ( decidua ) , is an immunologically privileged site. It means , the immune system doesn't do the actual function what it is intended for , in those sites. Even though ,  the trophoblast cells and the placenta carry antigens ( foreign molecules ) which are disparate to mother's immune system they are not attacked by the mother's immune cells. Since decidua is an immunologically privileged site , the immune system's usual reaction ( to attack foreign antigens ) is turned off ( by the secretions of the embryo ) and hence the immune cells doesn't hurt the embryo. Even in healthy pregnancies , the WBC count increases in your circulatory system. In other words , pregnancy can lead to an increased WBC in blood without any negative consequences to the developing fetus.

The success rate of an IVF cycle is not 100% , even with donor embryos. Sixty percent of women who are within 35 years of age , and who have good ovarian reserve  get pregnant within 3 IVF cycles ( not within 3 IVF transfers ! ) It is very natural to think that something is wrong with your body ( especially , the uterus ) when an IVF cycle fails. But the truth is , in 99% of the cases nothing is wrong . Not every embryo have the potential to implant and give rise to a healthy baby ( because of genetic defects in the embryo ) . We are still faraway from having a foolproof ART technology which could pin point which embryo will become a healthy baby. 

You just have to repeat your IVF cycle with donor embryos until you find success. Make sure that you are with a good IVF clinic which has high success rate.

Good luck !

Manju

Please read the disclaimer at the top right corner of this blog !

If you need to talk to me , write to me to manjupadmasekar@yahoo.com

Bliss

Yesterday , I received an email from one of my blog reader , my friend. She is now the mother to two beautiful kids ( twins ). She has struggled hard with infertility for years - she deserves the happiness she is now experiencing. She is such a nice person ; she is very kind enough to inform me when she was pregnant , many don't do so. She sent me the pictures of her children yesterday , and that made my day. There are so many women who write to me , but I never hear from them once they succeed - on my bad days , it just hurts.  I have watched the picture she sent me so many times now - the happiness in her face , the beauty in her children's face was amazing. 'A' , I wish you lots of happiness - happy motherhood ! You are one beautiful soul I met via my blog , and thanks for being so kind and compassionate.

Almost every woman whom I have met through my blog has attained their most beautiful dream - motherhood ! There are many ways to motherhood - adoption , IVF , IUI, donor eggs , surrogacy , donor embryos , the list is endless ! We must be thankful that we live in this age of easy information access , and in a age where science and technology are rapidly advancing and the benefits of it are available to us. I sincerely hope it becomes affordable for everyone too.

Long , long back I posted something here. I hope I could write more in the coming days. Anisha is doing good - couldn't believe that she is one year old already ! :)

Hope everyone of you are doing good. Good luck !

How lack of knowledge about infertility treatments can deny you the baby you need most !

This is an email I received from one of my blog reader. It is a privilege to receive emails from women whom I don't know personally - they open their heart and soul to me ! I am humbled by the fact that I am gifted to act as their confidante , their sounding board.

This email bares the heart of a woman who struggled to have a baby - but unfortunately who is not successful ! She nails the fact - how lack of knowledge about her own fertility ( or infertility ) and lack of money, prevented her from having the baby she most desired.

Although, there's a lot of self-pity in her emails, she is also very intelligent - she has understood clearly what deterred her from having a baby. This letter must be read by women struggling with infertility - not all wisdom have to be gained from your personal experience ! You can learn a lot from others' failure stories rather than success stories - that's why failure stories are precious when going through infertility !

I would be publishing more of patient queries and stories, hereafter. I would be happy to publish your success or failure stories, too. Please do write to me : manjupadmasekar@yahoo.com. I will not be revealing any of your personal details in my blog, you will remain anonymous - if you want to be so ! By sharing your story, you are sharing your knowledge and wisdom with many fellow women who are in need of knowledge, support and inspiration. So, please come forward to do so. 

Do leave your valuable comments, it helps a lot, too !

Hi Manju,

I know you are very busy with your baby Anisha.  I wish and your family best of luck.  Manju, I read your blogs very ofthen. Today I have read about how your education and your profession helped you a lot in your pursuit to ahve a baby and solve your infertility problem.  Ane you know, I am unlucky that during my school days I was not interested in science subjects.  I was such a fool that even after my marriage I did not know what is ovulation.  It is not that I was illiterate but that nobody talks to me about sex and and infertility.  I used to hear that God gives child to married couples and children born before marriage are illegal children.  When I faced the infertility problem I did not know which doctor to see.  What to ask the doctors?  And now I have learned so many things That I talked only of IVF and the procedure.  And I tell fertile couples that if IVF would have not have been expensive I would ask every fertile couple to try it at least once in their life to know what IVF is.  Even though I don't have a baby in lap, I have known what is pregnancy although for a little while.  Nobody can understand what I have undergone. How painful my journey of infertility was!  From zero knowledge of infertility I am now full of knowledge.  I read your blogs and I laugh  at my stupidity.  I wanted to be a good mother, to give my knowledge and to share my experience to my offspring.  I can not blame anyone nor can I say that God did not give the time to solve my infertility.  If only the government of my country would have thought about infertile couples in our country all the women of my age would not have suffered for a child of their own.  We infertile couples of our country have spent a lot but still our government is not talking about IVF to be introduced in our public hospitals.  We live in a country where education is free, health is free,  transport is free for students and old aged persons and our welfare state provided so much facilities to needy people. Old aged pensions, subsidies on Gas and what not do we get but no seriousness about infertile couple.  In the year 1972, the government introduced the Family Planning to control birth and the result is that nowadays they are talking of increasing population because we lack people in country.  By the year 2050 we will be have more old aged population than working population.  So, it will be a major problem to provide those people with old aged pensions.  You might be thinking why I am telling you all these.  Yes,  because I know how difficult it is to look for money to spend on infertility.  I stood alone to struggle this problem in my life and today I am back to square number one.  I could not raise my standard of living due to this problem.  I did not have the courage to adopt a child fearing of society and perhaps my greatest desire was to see my own genes.  Ever since I am married, I have found myself talking to myself.  I am always happy for couples who enjoy the happiness of their own child in their laps after having struggled so much.  There was a teacher of mine who got his baby girl after twenty years of marriage and he told me that it was the fruit of his prayer and now he prays a lot.  He even has a mandir built by him where he goes to pray morning and evening.  One day he told me that his infertility was due to his low count of sperm.  I have seen so many miracles happening.  IVF itself is a great miracle by Dr Edwards and Steptoe.  Had they not discovered this, so many infertile couples would not have been happy nowadays.  My infertility was due to high level of testosterone, endometriosis and blocked tube due to endometriosis.  All these I was not told by doctors, I discovered them on my own by reading and research and by doing blood tests. I don't understand why I am telling you all this.  Perhaps I am on holidays, idle and thinking and regretting my past.  Loneliness teaches you a lot.  Loneliness makes one realised how busy others are.  Once I had cursed myself with my jinxed tongue that "...........what if I come to be infertile?"  At that time I was only 20yrs old, not yet married.  Now I think well before talking.  I don't want to hurt anyone with my words.  There is nothing in life pleasant for an infertile lady.  There is nobody around her.  She is surrounded with memories and heartcries.  However hard I try to say let bygones by bygones yet I cannot forget how many times my private parts have been seen by different doctors.  Sorry.........................................