Good post from Dr. Sher

Here is what Dr. Sher himself posted on his forums (one of the founders and a good RE from SIRM -Sher institute)

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…………………………………….It is unfortunately not often appreciated that IVF should never be undertaken without a prior, thorough and comprehensive clinical and psychological evaluation. IVF is an emotional, financial and physical roller coaster which is only worth contemplating when you have reasonable expectations about the outcome. It is simply not good enough to jump right in to the process without undergoing an in-depth assessment of all the variables that can impact outcome. Always remember…., IVF is a classic example of the "chain being as strong as it’s weakest link". So “plan the trip, before taking the ride” or be prepared for a poor outcome.

Simply because a woman conceives once does not mean that she is just as likely (or even able) to be successful again. Let me pose two (2) theoretical examples to clarify what I mean:

Example #1: A woman with endometriosis has one baby with fertility drugs than cannot get pregnant a second time after repeated attempts with the same treatment: All women with endometriosis (regardless of severity) inevitably have to contend with the existence of “peritoneal toxins” in the pelvic secretions on the surface of and surrounding their ovaries, tubes and uteri .When upon ovulation, eggs pass from the ovary to the tube(s), they come in contact with this “toxic peritoneal factor” which renders the envelopment of the egg(the zona pellucida) less pregnable to sperm. As a consequence, such eggs subsequently 4 to 6 times less likely to be successfully fertilized upon arriving in the Fallopian tube(s).. This explains why a 35year old woman who has endometriosis will have about a 3% chance of conceiving per month of trying as compared with about 15% in for fertile woman of the same age. The “toxic peritoneal factor impacts on eggs that are ovulated (whether spontaneously or following the use of fertility drugs) and serves to explain why the chance of pregnancy is much reduced in normally ovulating women with endometriosis, regardless of whether fertility drugs and/or intrauterine insemination is used , or whether endometriotic deposits are removed surgically. An ovulating woman who fits the bill as outlined above in example #1, does have a chance (albeit markedly reduced) but this chance is markedly compromised and can only be improved by side tracking the toxins in the pelvis through IVF. .AND if such a woman were to conceive following spontaneous or induced, her chances of repeating her good fortune again, by the same approach would revert to being much reduced. It would be wrong for her or her physician to assert otherwise. But alas, all to often the prior pregnancy leads to a sense of false confidence that the same good fortune will again occur, just as easily as the first time. Often times this results in women trying cycle after cycle , often for years , only to be rewarded by “failure” and despondency. Eventually time runs out as, her egg quality declines with age and her ovarian reserve becomes depleted as she gets nearer to the pre-menopause.

Example #2: A 36 year old woman with endometriosis does IVF, has a baby but cannot conceive a few years later after trying IVF again and again and again…. The reason might be that 30% of women with endometriosis develop uterine natural killer cell activation (NKa) . This might not have occurred to the extent of precluding a viable pregnancy by her first IVF attempt, but now is in full force…resulting in a profound immunologic implantation problem. Going to IVF was appropriate but failure to keep an eye open for an emerging immunologic implantation problem…was in my opinion constitutes an error of omission. She might well have had another IVF baby had she undergone NKa down-regulation with IVIG 7-14 days prior to embryo transfer and perhaps had one follow up IVIF infusion upon the diagnosis of pregnancy!

So, simply because one confounding issue (e.g natural killer cell activation [NKa] is detected does not mean that other issues are not coexisting or in the process of developing.

my favorite part is his conclusion

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This is one of my biggest gripes about how IVF is often conducted because failure to perform a THOROUGH and comprehensive evaluation in all women undergoing IVF represents a serious error of omission and one that fundamentally compromises the chance of a success birth following IVF. After all, this is NOT about doing IVF, it is about having a baby and the cost of the latter not the former is what counts. Simply stated, if treatment for IVF is approached correctly and all variables that affect seed (embryo) quality and Soil (uterine receptivity) are evaluated and addressed thoroughly upfront, then the cost per baby (emotional, physical and financial goes DOWN). If you now cannot afford to be properly and thoroughly reassessed and treated, do not do another IVF. Save your money for the child you already have been blessed with!