During this event, Dr Olexandra Kozyra, PhD, Obstetrician-Gynecologist & Reproductive Specialist at Fertility Clinic Alternatyva discussed the main reasons for failed IVF attempts, advanced techniques to optimize your next cycle, and the role of personalized treatment in achieving success.
You already have a huge supplement in your treatment, like IVIG, which is a difficult medication and very expensive as well. You don’t need to use different kinds of embryos and try to get pregnant with any of these embryos. Furthermore, you need to find the optimal embryo and work with it. Regarding your uterus factors, it is very difficult to understand. It would be nice to find images or a video to understand where the fibroids and adenomyosis are located. The third stage of adenomyosis looks like a very difficult situation. I cannot tell you exactly what to do, but you might be a patient who can be accepted for the ultra-long protocol of preparation to avoid the bad influence of hyperestrogenemia and local hyperestrogenemia.
It depends on the type of endometriosis. Endometriosis is a pathological condition with many clinical options and types. Surgery can be done if, for example, you have cervical endometriosis, and you can remove the adhesions, which might help. However, if you have a diffuse type of endometriosis, surgery won’t work. You would need to take GnRH agonists for two or three months, and after that, stimulate your endometrium with replacement therapy. This should work in the best way.
Unfortunately, there are no supplements that can help grow your endometrium. If estrogen cannot help, supplements will not work. The best option is non-invasive treatments. One such treatment is uterine infusion, which sometimes helps. Another option is hysteroscopy with endometrial infusion of PRP, which can also help. However, speaking in terms of evidence-based medicine, these treatments are still in the D or C stages.
If we speak about the receptivity of the endometrium and the type of preparation for the embryo transfer, whether it should be a natural cycle or an artificial cycle, some immunohistochemical tests can help us. One example is the BLC test, which can help us understand if endometriosis or adenomyosis, adhesions, or other factors still influence the endometrium. For patients with difficult clinical presentations of endometriosis, we sometimes use this test, but it is not always effective for those who have certain types of endometriosis that are not clinically approved.
I believe this question is about the rise in temperature during a biochemical pregnancy. Typically, a slight increase in temperature—around 0.7 degrees Celsius—can happen, but it’s not specific enough to confirm a biochemical pregnancy. You should check with at least a urine test or, ideally, an HCG blood test.
It depends on the cause of the high temperature. I had a patient who lost a pregnancy due to a very strong antibiotic therapy, not just the temperature. So yes, high temperature can have an influence, but the underlying reason for the fever needs to be understood first.
In general, follicles larger than 21-23 mm can start showing signs of degeneration. Literature shows that if the cohort of follicles is large (e.g., 23-25 mm), there can be problems with egg quality. However, it depends on the patient. Some patients might have good maturation at 23 mm, while others might have degeneration at 16 mm. It’s very individual. In such cases, even if the first protocol is unsuccessful, we learn more about how to work with these patients in future cycles.
It doesn’t make sense to change the mitochondria if the oocytes are from the same person. Some oocytes will give you embryos and some won’t. In IVF, we aim to collect as many oocytes as possible because we need more material to create embryos, which increases the chances of a pregnancy. Mitochondrial donation involves changing the mitochondria, which could influence the oocyte, but this is not necessary if the oocytes are from the same person. The egg is the base for embryo development, and once it reaches the blastocyst stage, it needs to implant and receive nutrition from the uterus.
First of all, congratulations on being able to create embryos at 43. However, in your case, it may not be enough. You need to check the chromosomal integrity of the embryos. If you transfer untested embryos, there is a 70% chance of having aneuploid embryos at your age, and transferring untested embryos could lead to failed cycles. Even with good embryos, the success rate at 43 is lower. From my experience, the uterus can implant and deliver a baby even at menopause, but 60% of success is dependent on the quality of the embryos.
