2nd infertility and repeated implantation failure_1
Short Summary

41-year-old female with 2nd infertility and repeated implantation failure was treated with 4 long protocols with no success. The expert suggests to perform diagnostic hysteroscopy, hysterosalpingogram, and thrombophylia workup, to switch from the long protocols to a short one, and try to do double transfer or blastocyst transfer and consider assisted hatching as well.

Patient's Questions Medical Background

  1. Appendix removed in October 1987
 
  1. Laparoscopy April 2004 : results showed very mild Endometriosis
 
  1. Fertility treatment started in May 2004 : Clomid(50MG); Pregnal(5000 IU INJ); Menopur Vial
Became Pregnant in June 2004, but miscarried at 11 ½ weeks. Had a D&C procedure following my miscarriage.
 
  1. Mole removed September 2005 : results showed cancer cells,
Further surgery was performed in October 2005, to get a clear margin, Lymph nodes removed. All Clear was given in November 2005
 
  1. Colonoscopy on May 2006 , required as a precaution, as her Father died of Colon cancer in 1979 at the age of 47.
 
  1. 4 cycles of IVF treatment in Galway
1 cycle of IVF treatment in Athens
All with a negative result  

Expert's Opinion

It seems that this 41 years old lady suffer from 2nd infertility and repeated implantation failure.
She was treated with 4 long protocols with no success
The endometrium lining from the ultrasound charts seems OK.
I did not see the Athens chart. Only the 4 Galaway treatments.
 
At this stage I will suggest to perform:
  • Diagnostic hysteroscopy to verify that there is nothing in uterine cavity that prevents implantation.
  • Hysterosalpingogram to rule out hydrosalpings (especially since she is past D&C).
  • Thrombophylia workup to rule out another interfering factor.
Thereafter I would have switched from the long protocols to a short one (Menopure+Cetrorelix) and try to do double transfer or blastocyst transfer and consider assisted hatching as well.
In any case I will supplement the luteal support with at least daily aspirin 75mg.

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