Two months ago I had my first IVF cycle & it did not work. I was wondering what common reasons there are a body would reject the 2 embryos that seemed to look good on the 3rd day?
A few years ago I had a healthy child that came naturally with out even trying. In the past 2 years I’ve had an ectopic pregnancy resulting in removing a tube as well as a miscarriage. It’s hard to understand why it was so easy to get pregnant naturally a few years back & why everything we have done since that time has not worked. Also, if a fresh embryo transfer didn’t work on day 3, would you recommend trying a frozen transfer or a fresh transfer again.

Still Not Pregnant

Dear Still Not Pregnant,

I often hear patients refer to a failed embryo transfer as an embryo rejection. I suppose it appears to make sense as the embryos that are being transferred appear completely normal. The disconnect between what appears to make sense and the reality of the procedure of IVF is that the creation of life is an enormously complex process truly beyond the level of human understanding.

Great strides have been made in the process resulting in pregnancy rates exceeding 60% for some groups. However, the apparent quality and grade of an embryo predicts the likelihood of a resulting pregnancy. It is far from guaranteeing a pregnancy. New tests for the viability of an embryo are being developed such as metabolomics and proteinomics. These assess an embryo by analyzing products of an embryo in culture. They will further the likelihood of achieving a pregnancy from a transferred embryo.

Remember, that though an embryo may be otherwise viable it may still be abnormal genetically which will diminish pregnancy rates and usually result in miscarriage when implantation does occur. The likelihood of a genetically abnormal embryo developing increases especially as the age of the woman increases as well as with severely decreased sperm counts in the male.

The decision to go forward after a failed fresh transfer with a frozen transfer of sister embryos or a new fresh transfer should be individualized based on the quality and grade of the frozen embryos, the age of the woman, her

insurance coverage and her tolerance for the stimulation and retrieval as well as her motivation and patience. I recommend you have this conversation with your physician who can advise you better about your specific situation.

I wish you the best of luck!

I was at a meeting with one of the insurance companies when I was asked, “How do you educate patients regarding the risks of multiple pregnancy?” I realized that as much as I try to counsel patients and teach them that we had limited written materials and no audio visual. It was at that point that we decided to create our patient education program. First we hired an expert patient educator, Pamela Madsen, former founder and president of the American Fertility Association. With her assistance and with the help of my son Dan, we have produced a number of online tools for our patients:

We launched this blog, the fertililty doc, insights, information and musings on the world of fertility, infertility and reproductive medicine which covers everything from current news to new programs offered to informational videos and more.

We have developed a message board to assist patients in reaching out for answers to their questions. There is also a cycle buddy board that patients can utilitze to connect with and offer support to their fellow patients going through similar experiences.

The newest of our projects is an ongoing video series called Journey to the Crib: Fertility Talk with Pam and Dr. Dave which will consist of a new topic each week. We went with a casual format that actually takes place in the living room of my house.

Here are the first two episodes of Journey to the Crib, the first is an introduction to the series and the second one which is the topic for this week is High Order Multiple Births. I welcome you to visit our new educational sites as often as you wish. I hope they work to help educate you on fertility and increase your knowledge and awareness to help you in your own personal journeys. Please feel free to ask questions and to comment by clicking the comments button below.