What is Repeated IVF Failure?
Repeated IVF failure is defined as the failure to achieve a pregnancy following several in vitro fertilization (IVF) treatment cycles. Undergoing an IVF procedure and not having a successful healthy pregnancy is a devastating event in a woman and her partners’ life, thus always leaving us with the question “what caused the IVF failure?”
Causes of Repeated IVF Failures
(a) Embryo Quality:
Many embryos are not able to implant after transfer to the uterus because they are not healthy enough to grow. Even embryos that look good in the lab may have defects that cause them to die instead of growing.
(b) Age of the Eggs:
When it comes to IVF, the age of the eggs is more important than the age of the woman having IVF treatment. The quality and quantity of a woman’s eggs, known as her “ovarian reserve”, begin to get worse as she gets older, which may affect her chances of success with IVF as well. On average, only about 60 percent of transferred embryos go on to result in live births of babies.
(c) Ovarian Response:
Sometimes a woman’s ovaries don’t respond to the fertility medications strongly enough to produce multiple eggs. This is true especially if a woman is over 37 years or has higher FSH levels; she may not produce enough eggs to result in a number of embryos for screening and potential implantation, thereby raising the chances of IVF failures.
(d) Chromosomal Issues:
One of the major factors responsible for IVF failures is chromosomal abnormalities in the embryo. They account for most miscarriages and implantation failures in IVF cycles.
(e) Lifestyle Factors:
Women are recommended to stop smoking at least three months before IVF treatment. Also, women who are overweight or underweight are less likely to have successful IVF treatment. The bottom line is, “maintain a healthy weight”.
REPEATED IVF FAILURES: WHAT TO DO
We are aware that an unsuccessful IVF cycle can be financially and emotionally devastating. However, do not give up because pregnancy is still possible even after repeated IVF failures. Despite the tremendous improvement in IVF pregnancy rates, which is between 60% – 65% in our fertility center, few negative pregnancy tests are unfortunately still common (especially among women with diminished ovarian reserve (DOR).
Patients who still want to work and conceive with their own eggs have to expect that it may take more than one cycle to conceive. At Zeeva fertility center (ZFC), we learn from and improve upon every unsuccessful cycle. ZFC has treatment options that other centers cannot offer, which has set us as a leading fertility treatment center. These treatment options include:
(a) Pre-implantation genetic screening (PGS): This is the testing of the genetic equipment of embryos before transferring to the uterus, and has proven to be helpful in cases of recurrent IVF failures. PGS helps to identify chromosomally normal embryos.
(b) Endometrial Receptivity Assay (ERA): This is the most recent test of endometrial receptivity, which measures the amount of ribonucleic acid (RNA) that the cells of the uterine lining produce. ERA is so important because it is reproducible and very accurate at determining when the window of implantation is open; that is, “if the endometrium is receptive or not”. The most interesting part of the endometrial receptivity assay (ERA) is that it has identified that some women might have a receptive uterus at an earlier time than expected and some might be receptive at a later time. Infertility specialists can then use this information to change the time that embryos are placed into the uterus so that it matches up better with the window of implantation.
(c) Hysteroscopy: This is a minimally invasive surgical technique used in viewing and assessing the inside of the uterus (uterine cavity) to diagnose or treat fertility. It allows for removal of polyps and other uterine cavity abnormalities and has shown to increase the chances of women becoming pregnant after failed IVF attempts. Hysteroscopy is usually recommended if not done before IVF treatment, alongside with ruling out the possibility of genital tuberculosis.
(d) Laparoscopy: This is a minimally invasive surgical diagnostic procedure used to examine the organs inside the abdomen, such as ovaries, uterus and fallopian tubes. Laparoscopy may be recommended after repeated IVF failures, to allow the blocking of the fallopian tubes in case of gross hydrosalpinges, and to also clear endometriosis and cysts if any.
(e) Donor eggs and Surrogacy: Despite the 60% – 65% success in pregnancy rates at our fertility center, there are few instances where the patient needs to have multiple IVF cycles to get pregnant and deliver a baby. In other scenarios, a woman who is considered too old or has “premature aging” of her ovaries might not have a successful in vitro fertilization (IVF) cycle. Such patients may opt to use donor eggs and surrogacy as last options if required on case basis. Donor IVF allows the woman who otherwise would have no chance for pregnancy carry and deliver her own baby using the sperm from her husband. Donor egg cycles are considered less expensive than adoption.