In recent time, i have had to deal with clients with previously failed IVF treatment. They are disappointed, sad and even angry and bouncing back has been hard. Even though they understand that IVF doesn’t have a 100% success rate, it is hard to deal with failure. Every patient who starts an IVF cycle believes that the cycle is going to work.
When the cycle fails, hope goes crashing down and it is difficult to pick up the pieces and carry on living. This is why it is important to give yourself sometime; grieve; and then bounce back.
Rather than get stuck with the thinking about if only and blame yourself for the failure, you need to use an analytical framework, so you know what to do next.
Most patients get stuck in the phase of asking questions to analyze the failure. Doctor, did I do something wrong? Did the embryo fail to implant because I did not rest? Did the doctor do something wrong? Patients are often desperate and will spend hours browsing the internet to try to find answers to their questions. A useful question however, would be what can be learnt from this failed cycle and based on this hard earned information what can we do differently the next time to increase chances of success. It is important to note that not all the issues that influence IVF success can be corrected but some can be addressed to help make the next cycle more likely to result in a pregnancy.
Some reasons why IVF cycles fail.
1. Age. Age of female partner is the most important factor in predicting IVF success. As women age, their eggs get older, fewer eggs are produced and the quality of eggs declines. This begins to happen when you are in your 30s and the decline accelerates once you reach 37. The chance that an IVF cycle using fresh non donor eggs will result in a live birth is, on average, almost 32% for a 35 year old woman but only 12% for a 41 or 42year female.
2. Embryo quality. Another reason is poor embryo quality. Usually embryos fail to implant and grow because they have chromosomal or genetic defects. Again older eggs are more likely to result in poor embryo quality.
3. Ovarian response. The ovaries respond to the fertility medications with production of multiple eggs, which is critical to the chances of conceiving with IVF. You are likely to have a poor response if you are over 37 and/or have high FSH or low AMH.
Steps to take before next IVF cycle.
1. Review records of your cycle carefully. If it’s been a perfect cycle (grade A embryos, trilaminar endometrium of more than 8mm and an easy transfer), then often all one need to do is repeat until it works.
2. Tweak the superovulation protocol if follicles did not grow properly or the ovarian response was poor.
3. Change your doctor. If you have lost confidence in your doctor or if you find that after the failure your doctor is not being open or transparent and is not providing satisfactory answers, it is always a good idea to get a 2nd opinion to confirm if you are on the right track!.
4. Use donor sperm in cases of testicular failure and donor eggs in cases of poor ovarian reserve.
5. Many women will want to change the uterus when they encounter repeated IVF failure. It is important to note that the uterus is just a passive recipient and surrogacy does not help to improve pregnancy rates if the woman’s uterus is normal.
Finally, if you need to, alter life style to improve your chances of succeeding at IVF. Stop smoking, don’t drink alcohol or use drugs, eat a healthy diet, get enough rest and be kind to yourself and your partner. You are going through a stressful time with an exciting goal at the end.