HOW MANY ATTEMPTS OF IVF CAN BE TAKEN

In vitro fertilization (IVF) has been a miracle for so many couples around the globe suffering from infertility. Many people, including the educated lot think of IVF as a ‘one and done’ procedure that almost always works. Unfortunately, that does not always happen. But if you aren’t successful on the first IVF attempt, how many IVF cycles should you try before giving up?

How Many IVF attempts can you take?

It is a well known fact that the more number of attempts we take, our odds of success do increase with each attempt. But does that mean there is no limit to the numbers? To understand this, we will divide our discussion in three parts:

1. why IVF fails?

2. How safe is IVF?

3. Success rate of IVF per attempt.

WHY IVF FAILS?

After an unsuccessful IVF cycle, the next most important question is why it happened and whether we can improve upon the cycle. Previous IVF failures can provide us with 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 for stimulation, the follicular scans, number of oocytes retrieved, number and quality of mature eggs, number and grade of embryos, sperm quality, use of ICSI or other advanced technologies for fertilisation, thickness of uterine lining, fresh or frozen transfer.

To understand better, the popular ‘soil and seed’ theory can help us understand better. To grow a plant, we need a good seed, a fertile soil and a good environment. Similarly, whenever an IVF fails, either embryo (seed) or the soil (uterus) could be at fault. However, the commonest cause is still implantation failure, which means that a good embryo could not implant in a good endometrium as the connection between the two could not establish.

HOW SAFE IS IVF

With IVF, it is not uncommon to have several cycles of treatment in one or the other form before achieving a positive pregnancy and there are high doses of gonadotrophin injections required. Although these injections may cause mild nausea or bloating, these effects usually last only till the stimulation is ongoing. Other risks include ovarian hyperstimulation syndrome (OHSS), multiple gestations, ovarian torsion and risks of anaesthesia and egg retrieval procedure. We, at Vasundhara hospital Jaipur, aim to prevent any complications or undesirable experience by the patient. The first and foremost principle of our treatment protocols is ‘nonmaleficence’ or ‘cause no harm’. It is our own experience that most of the couples who were initially worried about IVF being a painful or taxing procedure ended up saying that it was much easier than they had previously thought.

SUCCESS RATE OF IVF PER ATTEMPT

There is nothing like success rate of a particular country or a centre. Couples need to understand their individualised success rates or the chances of ‘getting a live healthy baby’ in their particular case as it depends on a lot of factors like age of wife, medical reports and previous history of treatment.

In most of the advanced countries like USA and parts of Europe, the overall live birth rate for each IVF cycle started is approximately:

•        40-45% for women under 35 years

•        32-36% for women aged 35 to 37

•        22-28% for women aged 38 to 40

•        15-18% for women aged over 40

In India also, IVF technology has advanced a lot and good IVF centres have reached similar success rates.

WHAT ADDITIONAL CAN BE DONE FOR PREVIOUS IVF FAILURES

1. Poor ovarian reserve or poor egg quality (problem with seed)

1. Stimulation with high dose and good quality injections.
2. Mild stimulation with softer protocols aimed to achieve few good quality embryos.
3. Use of adjuvant therapy or supplements.
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.
5. use of donor eggs
6. TESA/ PESA for husband as testicular sperms may be sometimes better in case sperms in ejaculate show deranged parameters.

2. Poor endometrium (problem with soil)

In some cases, endometrium or the lining of uterus is very thin. Following strategies can be used:

1. Prime the endometrium for 2-3 cycles with hormones before planning for the actual transfer.
2. Doing a diagnostic hysteroscopy can be of much help in case uterus has partial septa or polyp which can be removed in the same setting.
3. Endometrial scratching or endometrial stimulation to improve the blood supply and the favourable growth factors.
4. Newer techniques like G-CSF or PRP (Platelet Rich Plasma) can do wonders in poor endometrium.
5. Supplements for endometrial growth.
6. Ultrasound monitoring with dopplers and 3D scans.

3. Personalised Embryo Transfer (improve interaction between seed and the soil)

Strategies aimed at improving environment may include:

1. FROZEN 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 it is better to freeze all the embryos and transfer in subsequent cycle. This is called a frozen embryo transfer (FET).
2. Evaluate autoimmune and endocrine factors thoroughly.
3. Blastocyst (extended) culture and day 5 transfer.
4. Some patients with thicker layer around embryos may need LASER assisted hatching.
5. Some couples may need PGT (Pre implantation genetic testing) to make sure that the embryos we are going to transfer are genetically normal.
6. Other therapies like the use of intralipids, immunoglobulins, heparins or steroids for recurrent implantation failures can be used in individual cases.

At Vasundhara hospital, we don’t follow ‘one size fits all’ kind of an approach. With us, it is a ‘personalised’ treatment plan. 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 a particular case. Our aim is to deliver the best possible results using our advanced and cutting- edge technology, round the clock available experienced embryologists and personalised stimulation protocols.

A lot of couples with previous failures got successfully treated with IVF at Vasundhara hospital Jaipur when they were just on the verge of giving up.

Life’s battles don’t always go

To the stronger or faster man;

But sooner or later the man who wins

Is the one who thinks he can.

by Walter D.Wintle

WE HOPE THAT YOU ARE OUR NEXT SUCCESS STORY……