Wednesday, 13 July 2016

Having a failed IVF cycle? Know what went wrong to have a positive 2nd IVF cycle

I have seen couples visiting clinic who have had failed IVF cycles before because of an improper execution of the IVF process by the concerned physician or are unsatisfied because of the poor lab quality and are hoping for a miracle. Their pain and grief is evident on their faces and I desperately wish to make every couple have a baby of their own and lead happier lives.

Even couples who succeed in the very 1st IVF cycle rarely come out unscathed. It is a fact that out of all those who embark on an IVF journey, only 40% receive positive results in the first cycle, while others question why this happened and what went wrong. The responsibility lies with the treating doctor to explain and address all the possible reasons for the failure. Usually, there are 3 basic reasons causing IVF failures. The foremost reason is that the embryo transferred into the intended mother’s uterus is abnormal or incompetent to result in a pregnancy. In most of these cases, an IVF fails due to an inconsistent number of chromosomes present in the embryo and the remainder is due to genetic or molecular embryo abnormalities.

Another possible reason is an implantation dysfunction that inhibits the embryo to attach to the uterus lining. This could happen due to the following:
a) A thin endometrium of less than 9 mm at the peak of estradiol stimulation
b) Surface lesions protruding into the uterine cavity
c) Immunologic dysfunction leading to implantation failure

Other reasons can be technical difficulties during the embryo transfer process, however, this occurs rarely.

If I were to distinguish among the above-mentioned factors, I would say “embryo abnormality” is the most common factor for IVF failures.

The latest introduction in genetic embryo selection technology is Comparative Genomic Hybridization (CGH), which enables us to distinguish those embryos which are chromosomally undamaged and are competent enough. However, CGH does not play any role in the chances of improving pregnancy rates. It only contributes to identifying embryos that are capable of promoting a possible pregnancy, reducing miscarriage risks, and decreased chromosomal birth defects like Down syndrome.

Who requires a CGH embryo analysis?
A CGH embryo analysis can be beneficial in cases with the following conditions:
a) Unexplained IVF failure
b) Recurrent miscarriages
c) Chances of multiple births, chromosomal miscarriages or birth defects
d) Women who do not want to preserve abnormal embryos

What are the success rates of 2nd cycle IVF?
Couples usually come up with reasonable questions with unexplainable answers. The chances of couples having a successful second IVF cycle depend on upon the following factors:
• Intended female partner’s age
• Quality and quantity of egg
• Quality and Quantity of Sperm
• Quality of IVF lab
• Expertise of the physician to perform Egg retrieval and efficiency in the embryo transfer process
• Quantity of eggs retrieved
• Uterine issues
• Genetic and chromosomal capabilities of embryo

If you wish to improve your chances of having a successful second IVF cycle, make sure that your concerned fertility doctor has considered the conditioned mentioned above. You can also consult another fertility specialist if you are not satisfied with the present one.

Closing Thoughts
• Get an honest idea about the chances of success with a 2nd IVF cycle from your fertility specialist
• If there are complications in the ovarian stimulation process then consider revising your medication protocol
• Abnormalities in the egg or embryo, then opt for an IVF clinic with highersuccess rates if the reason was poor IVF lab standards
• You can consider using donor sperm or donor eggs after a failed IVF cycle
• In the case of uterine issues, implantation failure is a common result as the embryos are not able to attach. In such cases, you might have to look at options such as surrogacy