I remain concerned that when IVF doesn’t work, a patient is too often given a diagnosis of carrying high levels of Natural Killer (NK) cells in her uterus, preventing implantation. In fact, it’s far more likely to be a problem on the embryo side – often related to older eggs – and the reality of this can be tough to face.
If it was a case of “well, looking for them and treating them can’t do any harm”, the situation might be more acceptable. However the diagnostic tests for NK cells are not well validated (meaning there may be lots of false results), and the commonly used treatment of prednisone (corticosteroids) may carry higher risks to mother and fetus.
Endometrial biopsy (or “endometrial scratch”) is a technique that is increasingly being used as part of IVF treatment. It’s a relatively simple thing to do – it involves passing a catheter through the neck of the womb (the cervix) into the uterine cavity and taking a small sample of the inner uterine lining (called endometrium), and sending it for analysis.
When IVF doesn’t quickly work, patients become convinced that there is something wrong with their uterus or body that leads to the “rejection” of their embryos. Of course this may be true for some women, but in fact the problem is usually one on the side of the embryo – even high grade blastocysts have up to a 50% chance of having chromosome errors that prevent implantation or lead to miscarriage. Well done studies repeatedly suggest that so-called “implantation failure” is far more likely to actually be a problem of embryos.
When a couple undertakes an IVF cycle we usually attain say up to a dozen eggs and following fertilisation and culture, there might ultimately be in the region of 1 – 4 applicable embryos at the day 5 stage. At that point, our usual advice is to transfer the best blastocyst and freeze the remaining blastocysts for later use.
…or “Why genetic anomalies of embryos are more likely to be important than taking steroids”
I’ve been very lazy with my blog lately but have decided to use my recent trip to the international conference ESHRE in Stockholm to give you some feedback about current activites.
One study that caught my eye was a Danish study that looked at the outcomes of couples who had had at least three early pregnancy miscarriages and how often they will ultimately go on to have a live birth.
One of the commonest statements I hear about so-called natural therapies is they don’t do any harm. Many people have a degree of scepticism as to whether they do anything, but an understandable reluctance to move to high powered mainstream medicine and on the well-meant advice from friends etc, I can readily see why people take natural therapy pathways.
One of the most interesting presentations I heard at the recent Fertility Society of Australia conference in Adelaide was not one about cutting edge science or new developments (as an aside, Sydney IVF’s technology is at the forefront of IVF practice but it’s always interesting to get other people’s views and directions). In fact the talk I found the most interesting was from Graeme Hugo, an expert on population, both Australia’s and worldwide.
This question was raised by someone who recently visited the blog. It raises some fundamentally important points about human fertility and the chance of conception. It strikes me that sometimes these concepts aren’t even recognised by some doctors!
The Sydney Morning Herald ran a front page article last week, noting that in the region of 1000 babies were missing (ie not conceived and born) as a result of the Australian Government’s cuts to rebates for IVF patients.