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Repeated IVF Failure

Repeated failures in IVF cycles (RIF) can be very distressing for a couple, especially when the underlying cause of the failures is unclear. We believe in evidence based medicine and therefore follow a logical and individualized approach to figuring out the most appropriate treatment options for each couple with previous failures.

 

A thorough review of the embryology details of your previous cycles by our experienced embryologists also provides helpful insights in selecting the right treatment options for you.

 

Since a lot of treatment modalities available in IVF such as embryo glue, assisted hatching or sequential transfer etc. are still highly experimental and lack reliable evidence, we think it is important to carefully discuss the potential benefits and pitfalls of the various options before selecting the appropriate treatment for you. Before we begin treatment, we also provide extensive counselling sessions with our team of clinicians and embryologists in order to assess your true likelihood of achieving a pregnancy which helps us in managing patient expectations better and helps couples in alleviating the stress associated with the uncertain nature of IVF.

It is also noteworthy, that while there can be a variety of factors that can affect your chances of success in IVF, the most crucial factor that can directly determine your result is the laboratory itself. In fact, most failures in IVF can be simply attributed to a poor lab. A good IVF laboratory making high quality embryos is all that is required to make a difference between failure and success in IVF.

 

Repeated failures in IVF cycles (RIF) may seem like the end of the road to many couples. But there could still be hope for many of these couples. We at our centre deal with RIF in the following three ways:

1. Identification and determining prognosis

It is possible to identify couples with previous failed cycles who are likely to make it in another cycle. Pre-treatment parameters like age, infertility duration, ovarian reserve tests, reason for infertility, past live births, sperm type, presence of hydrosalpinx, uterine factor and previous treatment history helps us determine your chance of making it in another cycle. Please note that we do not refuse women based on advanced age alone or those with low ovarian reserve markers (like AMH) from embarking upon another IVF cycle.

2. Individualized testing

Not all individuals require extensive testing. But based on your case history, tests offered to you could be one or more of the following: 

  • 3-D ultrasounds
  • Hysteroscopy
  • Laparoscopic correction of hydrosalpinx
  • Pre-implantation Genetic Testing of the embryo
  • Genetic testing of the endometrium (ERA)

3. Individualizing treatments

like stimulation protocols you receive, the dose and type of injections you receive, strategies like culturing all embryos to blastocyst stage and freeze-all, protocols for uterine preparation in frozen embryo transfers are all individualized based on your case history and clinical parameters. Individualization of treatment also includes patient friendliness, a stress on minimizing injections and keeping it as close to “natural as possible”. The eventual aim is to give you a single pregnancy that results in the birth of a healthy baby at term.

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Initial Assessment and Investigations

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Ovarian Stimulation and Cycle monitoring

Egg Retrieval and Sperm Collection

Fertilization (IVF or ICSI)

Embryo Development

Embryo Transfer

Embryo Cryopreservation (Embryo freezing)

Post Embryo Transfer Care and Pregnancy Test

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Initial Assessment and Investigations

Before the start of an IVF procedure, the couple undergoes some basic investigations  such as a semen analysis for the male and a few blood tests for both the female and male partner to establish suitability for IVF. If necessary, an evaluation of the fallopian tubes for the female partner may also be advised. Based on the results of these tests, we are able to design the best treatment strategy for you. Our individualised approach means that every couple will vary in how their treatment is planned and managed. 

Thereafter, the couple registers at the IVF centre, where they go through an extensive counselling session with our IVF counsellor. The patient is informed about all aspects of the IVF procedure they will be undergoing and is given an opportunity to ask questions and clarify doubts regarding the IVF treatment cycle.

Ovarian Stimulation and Cycle monitoring

The IVF cycle begins on day 2 or 3 of a woman’s cycle, which involves undergoing a round of blood tests and an ultrasound at the IVF lab, after which hormonal injections called Gonadotropins are prescribed. These hormones are given to stimulate the growth of multiple follicles in the ovaries. These follicles contain eggs. It is essential to take these injections daily for 8 to 12 days at the prescribed time to ensure optimal follicle growth. These injections are relatively painless, simple to administer and can be taken by the patient herself. During this period, the couple needs to visit the IVF center about 4 to 5 times for repeated blood tests and ultrasounds in order to monitor follicle growth. Once the follicles have reached a appropriate size, a final injection is given for maturation of eggs. This injection is usually taken at night following which an Egg pick up is scheduled 36 hours later.

Egg Retrieval and Sperm Collection

Egg pickup is a safe and relatively simple day care procedure performed in the IVF operation theatre under anaesthesia where eggs are retrieved through an ultrasound guided needle without any surgical cut or stitch. This process doesn’t require any hospitalization and the patient is discharged after a few hours of the egg pick up. 

The male partner also provides his semen sample by masturbation on this same day for further processing for IVF. Processing of semen involves removal of non-motile or dead sperm and only healthy motile sperm are separated for further use in IVF.

Fertilization (IVF or ICSI)

During the process of fertilization, the sperm is added directly to the eggs kept in a petri dish, thus allowing sperm to penetrate the egg and fertilize it. Alternately, sperm may be injected into each egg in a process called Intracytoplasmic Sperm Injection (ICSI). ICSI is generally performed for couples who either have low sperm counts or had a poor or failed fertilization in a previous attempt. On an average, only 60-70% of eggs that are retrieved will fertilize. Once an egg fertilizes, it produces a zygote the next day.

Embryo Development

Subsequently, the resulting zygotes develop into cleavage stage embryos on day 3. Not all embryos are alike, with some having better quality than others. The embryologist identifies embryos with good quality and separates them from the remaining poor quality embryos that may be slow growing, or fragmented or showing abnormal growth patterns.

Finally, on day 5 or day 6, an embryo forms a Blastocyst which is the final stage of an embryo. Not all embryos form a blastocyst. Only top quality embryos are able to reach the Blastocyst stage, and therefore these embryos have the highest chance of producing a pregnancy. Please click on the success rates tab to know more about the pregnancy rates after blastocyst transfer.

Embryo Transfer

Embryos may be selected for transfer into the patient on days 2, 3, 5 or 6 after her egg pickup. The day and number of embryos to be transferred is decided after discussion with the patient. Typically, only one or two, good quality embryos are transferred into a patient. Embryo transfer is a simple and painless procedure that does not involve the use of anesthesia. The developing embryo is transferred into the patient’s uterus with the help of a fine soft catheter inserted through the vagina. The patient is required to rest for only 10 – 15 minutes after the embryo transfer. At the time of leaving the center, the patient is given a date for the pregnancy test and written instructions about medicines to be taken up till the day of the test.

Embryo Cryopreservation (Embryo freezing)

After embryo transfer, any extra embryos remaining in culture can be frozen for future use. The technology used for freezing embryos is called ‘Vitrification’ which is a very robust technology, ensuring high survival rates of embryos after freezing. In case, an embryo transfer doesn’t result in a successful pregnancy, frozen embryos come in handy, as they provide the couple with an additional chance at conception, without having to go through another IVF cycle. Embryo freezing is also a very good option in cycles where either the number of eggs retrieved is too high, or the endometrium is found to be too thin or too thick on the day of embryo transfer. In such cases, it is advisable for all embryos to be frozen and embryo transfer to be performed in the next cycle to increase the chances of pregnancy.

Post Embryo Transfer Care and Pregnancy Test

Medicines are given to maintain hormone levels after embryo transfer to ensure that the uterus lining remains satisfactory. This improves the chance of implantation of embryos and thus of success. There is no evidence that prolonged rest improves the success rate of IVF.2 weeks after ET, a blood test will be performed to detect pregnancy. If the test result is positive, ultrasound is scheduled 3 weeks later to confirm the developing pregnancy.