IVF Failure and Short Luteal Phase: Fertile Thoughts
by Carlene W. Elsner MD
Q: I am forty and have been through IVF five times, with one pregnancy that ended in a loss at twenty-two weeks. I am now trying to get pregnant without IVF, as I can’t go through it again. My problem is a short luteal phase. Any advice on drugs or noninvasive procedures that might help me?
A: It is very frustrating to go through IVF five times and become successfully pregnant only to lose the pregnancy at twenty-two weeks. Do you know why you lost that pregnancy? Did you have testing to determine if the baby was chromosomally normal? You didn’t say how you did in your IVF cycles (number of eggs retrieved, number of eggs fertilized normally, quality and number of embryos transferred, and whether you had embryos to freeze.) Most, but not all, mid-trimester (twenty-two week) losses are for obstetrical reasons (like abruption placenta, chorioamnionitis, etc.) and are unrelated to chromosomal abnormalities in the fetus or to how you became pregnant (the IVF procedure itself), so it’s possible that you had very bad luck.
You say that your problem is a short luteal phase (less than nine days of temperature elevation by basal body temperature chart by definition), but I suspect that you have more problems than just that. Certainly, a luteal phase defect had nothing to do with your twenty-two week loss. Luteal phase defects, if they exist, are only a problem of the first trimester. Luteal phase defects are the result of insufficient progesterone production by the corpus luteum on the ovary (the site where ovulation occurred). Supplemental progesterone can be given to try to overcome this either by daily injection or vaginally in the luteal phase of the cycle, but luteal phase defects are usually only a symptom of a bigger problem and not the real problem itself. It is more likely that you have poor follicular development and egg development (this is common in forty-year-old women) and that is the reason your luteal function is deficient. In that case adding progesterone will be of little benefit.
Let’s look at what we know: Statistically, at age forty, regardless of how good your ovarian reserve is or how healthy you are, at least half of your eggs will be abnormal and if they fertilize the resulting embryos will be abnormal, and that assumes you have no other problems that affect your fertility. Abnormal embryos usually do not implant so that may explain your difficulty conceiving even with IVF.
At forty, it really is a numbers game. The more eggs and embryos you produce, the more likely you are to have at least one normal embryo to implant and grow successfully. The best way to get the most eggs and embryos is to do IVF, so IVF remains your best option to conceive. If IVF is not possible, you may want to consider using injectable fertility drugs to achieve a multiple ovulation each month in the hope of increasing the likelihood of releasing at least one good egg each month. The use of these injectable drugs should be coupled with intrauterine inseminations (IUI) for best results. The problem is that these drugs are expensive, so their use can quickly add up to the cost of an IVF cycle. You didn’t say what your partner’s sperm count is like. If the reason you did IVF is because his sperm count is poor, then giving you fertility drugs won’t solve that problem. Intrauterine inseminations are unlikely to work if sperm counts are below ten millions/ml with 50 percent motility. With counts higher than that, inseminations may be an option. I hope this information helps.
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