UNDERSTANDING IVF FAILURE AND THE WAY AHEAD
IVF is a journey towards parenthood and it may have its ups and downs. Although we wish that every patient who does IVF & should conceive, Unfortunately, IVF does not work all the time. It is therefore important for us to identify the reasons for failure so that we can decide how to go forward with the treatment with optimism. First, let’s look at some of the reasons for failure.
It is one of the commonest causes in IVF failure. Failure to implant can be because of a thin lining, a non-receptive lining, or a lining affected by genital TB. Existing immunological conditions make uterine environment hostile to the embryos. Poor quality embryos are rejected by the endometrium for implantation, hence quality of embryos is an important attribute impacting implantation.
EGGS & EMBRYOS
The major reason for IVF sometimes not being successful is that the embryos may not be of a good quality. They may look good from the outside but may not be good inside. This means that there may be genetic abnormalities in the embryos. In fact, the commonest reason for failure of the embryo to implant is that it is nature’s way to prevent a genetically abnormal embryo from implanting. The most common question that can be raised then is why embryos are unhealthy. Embryos can be unhealthy because of an egg problem or a sperm problem.. The chances of an embryo implanting greatly depends on the age of the woman.
Anti-Mullerian Hormone (AMH) is a hormone secreted by cells in developing egg sacs (follicles). The level of AMH in a woman’s blood is generally a good indicator of her ovarian reserve. Women with low AMH values may produce unhealthy eggs which may not implant.
Factors That Cause Decrease in AMH Levels
Increasing age & Obesity. Smoking , Alcohol Consumption & abuse of substances also contribute towards lowering AMH. Chemotherapy or Radiation Therapy and a prolonged use of Contraceptive pills may also impact AMH.
The sperm also contributes to the well-being of the embryo. Men with severe male factor, those with azoospermia due to genetic causes, men with diabetes may produce poor quality improves. In some situations, the ovary may not respond properly to stimulation and produce fewer number of eggs offer substandard quality. So after having talked about the eggs the embryo and the sperm.
ANATOMICAL ABNORMALITIES & OBESITY
Sometimes there is a Uterine septum (where the uterine cavity is partitioned by a longitudinal septum; the outside of the uterus has a normal typical shape) or a Unicornuate uterus (It is a rare genetic condition in which only one half of a girl’s uterus forms. A unicornuate uterus is smaller than a typical uterus and has only one fallopian tube.) and
One of the greatest inhibitors of success in IVF is obesity. Obesity may be attributed to poor quality eggs. For fertilisation and higher rates of miscarriage. Losing as little as 10 percent of your body weight can make a difference between failure and success
IVF Lab is the heart of an IVF center. It is here that the sperm and egg are combined to create life. The embryos are very sensitive to change in oxygen concentration, carbon dioxide concentration humidity. PH temperature and light. Hence IVF Lab is of paramount importance. Trained embryologist with lots of experience can make a difference between success and failure.
If the correct dose of hormone injections or the right type of hormone injection is not given it can lead to a poor recruitment of eggs and therefore poor quality of embryos. This could result in implantation failure as well. The dose of Hormones can vary from cycle to cycle based on the previous experiences of the clinician and the patient.
One of the most important things that can result either in success or failure is the way the embryo transfer is done and therefore it is the most important procedure in IVF. A smooth embryo transfer paves the way to success. The type of catheter used, the direction and depth to which the catheter is placed in the uterus contributes to success. Also, if there is trauma to the uterus during the embryo transfer it can decrease the chances of implantation.
THE WAY AHEAD
Correction of medical conditions such as hypothyroidism or hyperthyroidism, loss of weight, quitting smoking. Correction of high blood pressure and high blood sugar can contribute to success.
IVF failure can be a stressful procedure. It is very important to remain calm during the IVF cycle. You should not be under psychological stress. Yoga, meditation, walking can destress a couple.
Trusting your clinician in your path to success is the most important thing after an IVF failure.
A psychologist psychiatrist or counsellor can take away your anxiety and contribute to your success.
We wish you all the best in your path towards parenthood.