The first IVF cycle will often be successful at a high quality IVF program. One of the most frustrating situation for patients and clinicians is the failure of such a well progressing cycle.
Failed treatment cycle is a heart rending condition. After investing an enormous amount of hope, emotion, time and money, a negative result can be devastating. It is bound to leave one feeling empty.
Even though it is understood that IVF doesn't have a 100% success rate, in the heart of their hearts, every patient who starts an IVF cycle believes that this cycle is going to work. And then if it does not succeed, it becomes very hard to deal with the failure and bounce back.
It is important to understand that IVF is not a miracle solution; instead, it is the most successful treatment when all other fertility treatments have failed.
Pregnancy rates with IVF/ICSI are in the range of 40-50% per cycle. Hence, unfortunately many couples may not conceive at their first cycle of IVF and will need to consider a second cycle.
If it's been a perfect cycle with good quality of embryos and a good lining of the womb, then often all one needs to do is to repeat it until it works. This requires a lot of patience, fortitude and support from the treating team.
When faced with such a situation do consider taking a break, understanding why your treatment didn’t work and planning your next step.
•Taking the leap into a fertility journey is stressful. So when a treatment doesn’t work, it's important to give yourself some time to recover emotionally and physically and then bounce back and decide your next step.
• We recommend that you wait for a couple of months before trying again, allowing ample time for your body and mind to recover before we reassess your options.
•Consider seeing a counselor to help you to talk through your feelings.
•When you feel ready, schedule a follow up consultation to go over with what might have been learned from the failed IVF attempt. Based on this additional hard-earned information, we can plan what we can do differently the next time to increase our chances of success.
•We would also discuss about if and when you should try again, a different method if available, things to do to boost your chances next time.
•If using donors or surrogates may improve the success rates, then this can be discussed.
A follow-up visit is strongly encouraged to explore the reasons for not getting a positive outcome. Usually things go wrong for a few reasons like:
•Suboptimal sperm quality or known sperm problems necessitating ICSI.
•Suboptimal egg quality which may be seen in women with polycystic ovaries, endometriosis, low AMH levels and those over 35 years of age. As women age the incidence of chromosomal abnormalities in eggs and therefore in embryos, increases significantly. It starts in the early 30s, so that by the mid-40s a very high percentage, over 75%, of human embryos are chromosomally abnormal.
•The ovaries don’t respond to the drugs used to stimulate egg production, so no follicles (egg sacs) grow and this leads to cancellation of the IVF cycle.
•Sometimes follicles develop but without an egg within, this is called empty follicle syndrome. In this case no eggs are found during egg collection.
•At the other extreme, the ovaries may over respond and may give immature eggs. Sometimes, collected eggs fail to fertilize, so no embryos develop.
•Sometimes embryos fail to grow in the lab, so cannot be transferred to the womb. Unfortunately, sometimes embryos that grow well initially stop growing later. This is likely to happen because of some inherent genetic defects in those embryos. Hence, some of the embryos that despite looking healthy in the laboratory will stop growing after they are transferred to the womb. This is a reason for IVF failure in large majority of cases.
•Thin lining of the uterus (endometrium) or insufficient blood supply in the uterus can affect implantation. Hormonal imbalances are also sometimes responsible to put the uterus out of phase for receiving the embryo.
•Most importantly, the “chance” per cycle. Only around 40% of cycles at best reach a successful outcome. This implies that even if all goes well, failure might be unexplained and implies the need for more cycles or attempts.
•Repeat cycle, maybe with a change in dose of stimulation medications, type of protocol, timing of the HCG trigger shot or a different method. The data gathered from the previous failed cycle can be reviewed so that the repeat cycle can be planned with possible improvement. If the follicles did not grow properly, or the ovarian response was poor, higher dose of injections can be used to get more eggs of better quality. Unfortunately, despite the best planning, the outcome can be unpredictable.
• Instead of transferring the embryos in the same cycle, all embryos can be frozen and transferred at a later date. This can be done in women with a thin lining of the womb, low ovarian reserve, repeated early miscarriages and those at a higher risk of ovarian hyperstimulation.
•Use of endometrial scratching or intrauterine instillation of G-CSF can improve the receptivity of the uterus and implantation chances. Research has shown that endometrial biopsy stimulates tissue remodeling that causes local release of factors that promote implantation. Hence in case of thin endometrium in the previous failed IVF cycle or repeated implantation failures, an endometrial biopsy is done before the stimulation cycle. Estrogen and sildenafil medication can also be used to improve blood flow in the womb, to improve the chance of implantation. In addition, acupuncture is believed to enhance endometrial receptivity but the scientific evidence is lacking.
•Hysteroscopy can be performed to assess the uterine cavity and correct any abnormality to improve the implantation rates in the subsequent cycle.
•Infection screening can help determine and treat the cause of early implantation failure.
• Immune testing in a select group will help suggest immune therapy to improve success.
• Karyotyping of both partners can help determine genetic cause of failed fertilization or early repeated miscarriages.
•Donor eggs can be used to maximize success rates in cases of repeated IVF failure due to poor egg quality or in women with poor ovarian reserve and premature menopause.
•Donor sperm can be used in case of repeated failures of ICSI which was done for issues with sperm quality.
•Donor embryos can be used in case of both eggs and sperms being of poor quality.
•Surrogacy is recommended when there are repeated implantation failures owing to poor quality of endometrium or other problems in the uterus.
Here's everything you need to know about IVF
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