Never Give Up! As, pregnancy is very much possible after a Failed IVF Cycle
A failed IVF cycle can be emotionally and financially devastating. We very well know this as a lot of our patients come to us after having at least one failed IVF cycle at another fertility centres. At Vasundhara hospital and fertility research centre Jaipur, we specialize in dealing with “difficult cases” of infertility. Many patients visiting us had previous one or two IVF failures, and centres had denied them further treatment unless patients agreed to use donor eggs.
At Vasundhara hospital, Jaipur, we are committed to helping couples achieve pregnancy with their own eggs and sperms, which is the dream of every couple.
After an unsuccessful IVF cycle, the next question is whether we can improve upon the cycle. Previous IVF failures can provide us a good clue about the next plan of action. The only way to get better is to go through the previous records thoroughly, the injections used, the follicular scans, number of oocytes, mature eggs, number and grade of embryos, semen quality, use of ICSI or other advanced technologies, endometrial or uterine lining, fresh or frozen transfer.
If you are one of these patients with previous failed IVF cycles, you are just a click away. IVF Treatment in Jaipur
Why IVF Cycles Fail
When a patient with previous failure approaches, it is important to understand where and what went wrong.
- IVF cycle cancellation, prior to egg retrieval, because not enough follicles are produced.
- Cycle cancelled after egg retrieval 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 mother’s uterus for a variety of reasons.
- Pregnancy happened but did not result in a live birth of a baby.
Previous IVF Cycle Cancelled
Out of 10 patients with previous unsuccessful IVF attempts, around 2 patients will have previous cycle cancelled due to less than expected number of follicles demonstrated on ultrasound. Cycles cancelled for unexpected poor response can still be justified as next cycle can be started with a higher dose of gonadotrophins, resulting in better outcome. But in cases where ovarian reserve is already poor because of advanced age (> 35 years), low AMH, less number of follicles on a baseline scan, The one most frequently encountered is that most IVF centres routinely cancel IVF cycles if the patient does not demonstrate a minimal number of follicles on ultrasound. Such cancellations make sense only if we can hope for a better stimulation either using higher dose of injections or with the use of adjuvant therapy. In cases with poor ovarian reserve, we have to be absolutely clear in our mind that we will get less numbers only and we should proceed rather than letting the cycle go waste and depriving the woman of the very last chance of conceiving with her own eggs. Ultimately,it takes just one egg and one embryo for pregnancy to happen!
Poor ovarian reserve or poor egg quality
These days infertility because of advanced age of female partner has become a trend because of delayed marriages, postponement of childbirth and various lifestyle factors. Even young girls are having low AMH with disturbed hormones. These cases are to be dealt with using a different approach.
Options for poor responders willing to use their own eggs are:
1. Careful stimulation with high dose and good quality injections.
2. Mild stimulation with softer protocols to achieve a few but good quality embryos.
3. Use of adjuvant therapy, which may need to be taken for one to three months.
4. Pooling of embryos (egg collection for 2-3 cycles in the same cycle without a break). This has helped a lot of such couples who were otherwise refused for self-eggs at various other IVF hospitals in Jaipur.
We try to give the best possible chance to such women as we don’t deny them of this opportunity rather we fight for every single egg as we see each egg as an opportunity to give a baby.
Absent or poor quality sperms
We get a lot of couples with husband semen analysis showing absent sperms (azoospermia) or poor quality sperms (oligo-astheno-teratozoospermia). Even with such reports, we offer them counselling and plans where we can retrieve sperms directly from the testes by doing surgical sperm retrieval techniques like TESA/ PESA/ TESE. These sperms are much better to use for IVF-ICSI as these sperms are not exposed to the oxidative stress that sperms have to go through while travelling through the male reproductive system. This is a simple procedure and only requires local anaesthesia in most cases. Using testicular sperms can offer us better chances of conceiving after IVF, in cases of severe derangement in semen parameters or in conditions like varicocele. Men with deranged reports should also be put on vitamin and antioxidant therapy to further improve the quality of semen.
Personalised Embryo Transfer
We all understand a basic IVF cycle where embryos are transferred 3-5 days after oocyte retrieval. This is called fresh transfer. In some cases, where the hormone levels are extremely high or lining of uterus is not good, it is better to freeze all the embryos and transfer in subsequent cycle. This is called a frozen embryo transfer (FET). Whether a fresh or a frozen transfer is better is a matter of big debate. At Vasundhara hospital, we don’t follow ‘one size fits all’ kind of an approach. With us, it is an ‘individualised’ approach. With advanced 3D and 4D ultrasound assessment of endometrium along with colour dopplers and assessment of hormone levels, it is always better to find out which approach is going to be safe as well as most effective in your particular case.
Poor endometrium
In some cases, endometrium or the lining of the uterus is very thin. In such cases it is better to prime the endometrium for 2-3 cycles with hormones before planning the actual transfer. Doing a diagnostic hysteroscopy can be of much help to look at certain subtle problems with the uterus like partial septa or polyp which can be removed in the same setting. Sometimes, we may need to do endometrial scratching or coring to improve the blood supply and the favourable growth factors. A number of other techniques like instilling G-CSF or PRP (Platelet Rich Plasma) can do wonders. There are also a number of supplements, which, if used carefully can help achieve a good endometrium and a healthy pregnancy. It is very important that the IVF consultant only does the ultrasound scans carefully assessing the thickness, pattern, blood supply and volume of the uterine cavity. Ultimately a healthy tree can grow only if the soil is healthy!!
Unexplained implantation failures
Even with the advent of latest scientific technologies, IVF has not been able to deliver a guaranteed success. Even the best of patients with good quality embryos and endometrium may get a negative result. In such unexplained cases, it is important to evaluate autoimmune and endocrine factorsthoroughly. Sometimes, extended culture till blastocyst stage and then transferring may offer better results. Some patients with thicker layer around embryos may need LASER assisted hatching. Some couples may need PGT (Pre implantation genetic testing) to make sure that the embryos we are going to transfer are chromosomally normal.
Other therapies like the use of intralipids, immunoglobulins, heparins or steroids for recurrent implantation failures can give us better results in carefully selected patient population.
IVF using donor eggs
Donor eggs is the last option for those who have depleted all their eggs, leaving behind no scope of using their own eggs. Sometimes known genetic factors leading on to recurrent pregnancy losses also precludes the use of self -eggs. But remember, it should be adopted as the last and not the first option even if you have less number of eggs left. It is understandable that donor eggs will offer better chances of getting pregnant but then don’t deprive yourself of that only chance of your own eggs. Although, there are cases with clear cut indication for donor eggs or even donor embryos. Donor egg IVF allowssuch woman who otherwise would have no or very little chance of getting pregnant, to carry and deliver her own baby using the sperm from the husband. We also offer very successful donor programs but that is after a detailed counselling and consent.
At Vasundhara hospital, our approach is different. What makes Vasundhara hospital Jaipur different from some of the IVF centres in Jaipur only interested in the rat race of delivering best success rates forgetting the real purpose of IVF.
1. Transparent services with detailed counselling before starting the process so that patient is sure and completely aware of the process.
2. Couple is actively involved in decision making.
3. Trying with self- eggs and sperms, even in most difficult of the cases. Couple is explained about better success rates with the use of donors but is always given that best chance of getting their own ‘genetic child’. It requires a real hard work, working on couples with previous failures and compromised ovarian reserve but we do that!!
4. We always try to deliver the best possible results using our advanced and cutting- edge technology, round the clock available experienced embryologists and personalised stimulation protocols.
REMEMBER THAT SUCCESS RATES OF IVF CAN NEVER BE 100% BUT WE HAVE TO STRIVE FOR EACH AND EVERY PERCENT. TO KNOW ABOUT THE ACTUAL SUCCESS RATE OF IVF, PLEASE READ OUR BLOG ON IVF Success Rate
WE TRY OUR BEST TO DO WHATEVER WE CAN DO TO MAKE IT HAPPEN FOR YOU. A LOT OF COUPLES WITH PREVIOUS FAILURES AND HAVING GIVEN THE OPTION OF DONOR EGGS ELSEWHERE GOT SUCCESSFULLY TREATED WITH IVF AT VASUNDHARA HOSPITAL JAIPUR USING THEIR OWN EGGS.
WE HOPE THAT YOU ARE OUR NEXT SUCCESS STORY……
