DON’T Give Up! A, pregnancy is very much possible even after a Failed IVF Cycle
A failed IVF cycle is emotionally and financially draining. A lot of couples come to us after having at least one failed IVF cycle at one or the other IVF centres. At VANSH IVF centre Jaipur, we specialize in dealing with such ‘challenging cases’ of infertility. Many patients visiting us had previous one or two IVF failures, and had lost all their hopes of being able to become parents.
After an unsuccessful IVF cycle, the big question is how we can improve upon the next cycle. Previous IVF cycle records can provide us a good clue about the putative reason for failure. The only way to get better is to go through the previous records thoroughly, the injections used, the follicular scans, number of oocytes retrieved, number of mature eggs and their quality, number and grade of embryos, semen quality, use of ICSI or other advanced techniques, day of embryo transfer, endometrial or uterine lining at the time of embryo transfer, fresh or frozen transfer.
If you are one of those with previous failed IVF cycles, we are just a click away.
REASON BEHIND IVF FAILURES
When a patient with IVF previous failure approaches, it is important to understand what could have gone wrong.
- IVF cycle cancellation before egg retrieval, because of poor response to injections.
- EGG pick up done but embryo transfer not done as no mature eggs were retrieved, failed to fertilise or poor quality non transferrable embryos.
- Implantation failure: Transferred embryos may not implant or attach to the mother’s uterus for a variety of reasons.
- Pregnancy happened but did not result in a live birth of a baby.
Previous IVF stimulation Cancelled
Many patients with previous unsuccessful IVF attempt have previous cycle cancelled during egg stimulation due to less than expected number of follicles on serial ultrasound. Unexpected poor response to IVF stimulation can be managed by carefully planning the dose and type of injections. But in cases where ovarian reserve is already poor because of advanced age (> 35 years), low AMH, less number of follicles on ultrasound scan, we counsel the patient about what we expect in their case. If the couple agrees to go ahead even with low egg yield, then let us give them the best possible chance. Pooling of embryos by doing 2-3 consecutive egg retrieval cycles also helps in such cases. We should not deprive the woman of the very last chance of conceiving with her own eggs. Ultimately, all we need is just one good egg and one embryo for a pregnancy to happen!
Poor egg quality
These days infertility is on rise because of advanced age of female partner, delayed marriages, postponement of childbirth and various lifestyle factors. Even a trend towards having low egg reserve in young age is being seen due to stress and various environmental factors.
In cases where we suspect poor egg quality could be the reason for failures, we may plan a different stimulation protocol. Some women respond to different type of injections, some may need higher than usual dose. Quality of injections being used may make a huge difference in egg quality.
In some, but not all cases, milder stimulation protocols may give us good quality embryos. This needs to be individualised as this won’t work for all. Use of adjuvant therapy or supplement to energise eggs may work. This therapy may need to be taken for one to three months. Some lifestyle modifications, diet, exercise, stress management may help.
Pooling of embryos (repeated stimulation and egg retrieval for 2-3 consecutive or even same cycle without a break). This has helped a lot of such couples who had left the hope of conceiving with self-eggs at some other IVF hospitals in Jaipur.
Individualising each case is very important in previous IVF failures.
Poor quality sperms
There are cases where male partners have poor quality sperms (oligo-astheno-teratozoospermia). In such cases some supplements may need to be given to improve the sperm quality. In cases of absent sperms in semen (obstructive azoospermia), we can retrieve sperms directly from the testis by doing TESA/ PESA/ TESE. Even in cases with very poor sperm quality, sperms retrieved through TESA/ TESE/PESA may show better quality as these sperms are not exposed to the oxidative stress that sperms go through while travelling through the male reproductive system. This is a simple procedure and can be done under local anaesthesia in most of the cases. Other conditions affecting sperm quality like varicocele may be taken care of using antioxidant therapy or in some cases surgical correction. In cases of testicular failure, where there is no possibility of use of self-sperms, we may need to go for donor sperms, after proper counselling and consent.
Personalised Embryo Transfer (PET)
In a basic IVF cycle embryos are conventionally transferred 3-5 days after egg retrieval. This is called a fresh embryo transfer. In many cases, the hormone levels are extremely high due to development of multiple eggs. This may negatively impact the lining of uterus. It is therefore better to freeze all the embryos and transfer in subsequent cycle. This is called a frozen embryo transfer (FET). At Vansh IVF JAIPUR, we don’t follow ‘one size fits all’ kind of an approach. With us, it is an ‘individualised’ approach for all. Recent studies point towards better success rates in IVF with frozen embryo transfer. With advanced 3D and 4D ultrasound assessment of endometrium along with Colour Doppler’s and assessment of hormone levels, we can find out which approach will be better in your case. Sometimes patients with multiple IVF failures, we may do a testing called ERA (ENDOMETRIAL RECEPTIVITY ARRAY) to find out if the window of implantation is displaced. We then plan embryo transfer according to that best window in which chances of implantation are maximum.
Poor endometrial quality
In some cases, endometrium or lining of the uterus is not optimal. It may be thin or the blood flow may be compromised. Sometimes, the pattern which should be 3 layer is not well defined. In such cases may be better to prime the endometrium for 2-3 cycles with hormones before planning the actual transfer. Performing a hysteroscopy can help us look at certain subtle problems with the uterus like partial septa or polyp which can be removed in the same setting. Some office procedures like endometrial scratching or G-CSF or PRP (Platelet Rich Plasma) instillation can improve the outcome. At VANSH IVF centre JAIPUR, we had a series of patients with thin endometrium where hysteroscopy and sub-endometrial PRP instillation led us to good lining and positive results in patients with previous IVF failures. There are also a number of uterine supplements, which can be used to improve the quality of endometrium. It is very important that the IVF consultant does the ultrasound scans on his own. A careful assessment of the thickness, pattern, blood supply and volume of the uterine cavity should be done. Ultimately a healthy plant can grow only if the soil is healthy!!
Unexplained implantation failures
Even with so much advancement in science and advent of newer technologies, IVF has not been able to deliver a guaranteed success. Even few cases with good quality embryos and endometrium may get a negative result. In such unexplained cases, we may still find some reason like autoimmune and endocrine factors.
BLASTOCYST TRANSFER
Blastocyst is an embryo which has been cultured till fifth day. Blastocyst (day 5 embryo) in comparison to Day 3 embryo is already filtered and has a proven growth potential. We may even plan for a single embryo transfer in cases where we have blastocyst. Some couples may need PGT (Pre implantation genetic testing) to make sure that the embryos we are going to transfer are chromosomally normal. These techniques may not be available at all IVF Centres of Jaipur. So choose wisely when planning a fresh IVF after previous failures.
Few therapies like intralipids, immunoglobulins, low molecular weight heparins or steroids for recurrent implantation failure cases may give us better results in carefully selected patient population.
IVF using donor eggs
Use of Donor eggs is the last option for those who have extremely low ovarian reserve or in cases where age of woman is advanced. After a careful initial assessment, based on your age, AMH levels, number of follicles seen in ultrasound, we can decide if a woman needs donor eggs or not. Sometimes cases with known genetic factors leading on to recurrent pregnancy losses also need donor eggs.
At VANSH IVF JAIPUR, our ‘INDIVIDUALISED IVF ’approach has helped many couples with previous IVF failures to materialise their dream of parenthood. This has made VANSH IVF JAIPUR one of the Best IVF Centres in Jaipur.
Transparent services, ethical practice with our advanced and cutting- edge technology, round the clock available experienced embryologists and personalised stimulation protocols has helped us achieve very good success rates of IVF in JAIPUR.
REMEMBER THAT SUCCESS RATES OF IVF CAN NEVER BE 100%. BUT WE STRIVE FOR EACH AND EVERY PERCENT BECAUSE WE KNOW HOW MUCH THAT MATTERS TO YOU.
WE HOPE THAT YOU ARE OUR NEXT SUCCESS STORY……
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