Recurrent IVF failure … why ? what can be done ?

Why  I get repeated failure while doing IVF?

 

When a couple plans for an IVF , their expectations reaches at high level. Because getting a kid is the most  wealthy gift in the life of infertile couple. But when first cycle of IVF  fails , couple’s panic level and anxiety increases .

As they land up in recurrent IVF failure ,that becomes devastating situation for them. Then they start asking  question , like Why  I get repeated failure while doing IVF?

why I landed in to this phase? .

In this article we are grossly analysing the causes of recurrent IVF failure.

First we will understand what is recurrent IVF failure ?

Definitions varies according to many journals , but “ Failure to achieve pregnancy following three cycles of IVF , where three good quality embryos have been transferred ( fresh or frozen ) in each cycle   , is called as recurrent IVF failure .”

Causes —

It may be at various level

  • The egg.
  • The sperms .
  • The embryo.
  • The woman’s uterus .
  • Maternal and paternal health .
  • Technical problems while doing IVF.
  • Combination of these .

PROBLEMS AT OOCYTE LEVEL —

As we know, maternal age has inverse relation with IVF success. This happens because as age advance chromosomally abnormal egg increases. Chromosomally abnormal egg produce abnormal embryo. Naturally, uterus does not accept abnormal embryo, that is normal phenomenon, but for couple who undergoing IVF, this is nightmare.

Reduced ovarian reserve is also cause of recurrent IVF failure because less number of eggs produced per cycle and getting good quality embryo becomes difficult.

If patient has past history of Endometriosis or ovarian surgery then also egg quality hampers.

In case of patients with severe PCOS, egg quality many times is not good.

How to tackle this problem?

Always handling this problem is not easy and at many times not possible also.

Early decision of IVF is really a good solution for tackling this problem.

As we know, maternal age has inverse relation with IVF success. This happens because as age advance chromosomally abnormal egg increases. Chromosomally abnormal egg produce abnormal embryo. Naturally, uterus does not accept abnormal embryo, that is normal phenomenon, but for couple who undergoing IVF, this is nightmare.

Reduced ovarian reserve is also cause of recurrent IVF failure because less number of eggs produced per cycle and getting good quality embryo becomes difficult.

If patient has past history of Endometriosis or ovarian surgery then also egg quality hampers.

In case of patients with severe PCOS, egg quality many times is not good.

How to tackle this problem?

Always handling this problem is not easy and at many times not possible also.

Early decision of IVF is really a good solution for tackling this problem.

Increasing stimulating drugs to obtain more eggs can be tried.

Addition of drugs like growth hormone and androgen can be thought of.

PGD & Oocyte Donation program can be tried .

PROBLEMS AT SPERM LEVEL–

The sperms –

Sperm moves inside the female eggs and transmit the DNA from male partner and make healthy embryo.

If sperm function is poor or DNA is fragmented then possibility for forming good quality embryo reduces.

Infected semen can cause IVF failure .

Why this happens ?

Life style ,obesity, alcohol consumption , smoking, substance or drugs abuse, use of steroids and some medications  , working at very  hot environment, using very tight undergarments ,?use of laptops on lap for long time ,? using mobiles in lower pockets .

Genital infections like MUMPS , genital TB, OR STDs

Any trauma to genitals .

Vericocele  , hydrocele hernia  type medical   condition

Sperms life cycle is 72 hours ,if a person is ill or stressed , it can temporarily affects his sperms quality.

How to handle this situation?

Again handling this problem is not easy and  at many times not possible also .

Use of Antioxidant medication

Changes in lifestyle like stopping alcohol consumption, quit smoking, daily exercise.

Use of loose undergarment, restricting  use of laptop, mobile.

Changing job to less hot area .

Corrective surgery for hernia , hydrocele vericocele .

Prompt treatment of genital infection and maintaining genital hygiene.

Frequent ejaculations.

ICSI  or donor sperms

TESA- it has been shown in few studies that sperms retrieved from TESA sample has less DNA fragmentation. it can be used for ICSI.

 

PROBLEMS AT EMBRYO LEVEL —

 

 

The Embryo —

As I mentioned above it is the function of uterus to reject abnormal embryo, so even this is normal phenomenon for couple undergoing IVF it is devastating.

Why this happens?

Abnormal chromosome compliment –less numbers of chromosomal pair, deletion,  and translocations type of abnormality due to advancing age of female partner. This is one of the most common causes in recurrent IVF failure.

Abnormal embryo growth or development like fragmented embryo, maturation arrest at  various stages. Advanced maternal age reduces embryo health.

Thicken egg shell ( Zona ).

 

How to handle this situation?

IVF

IVF with Blastocyst culture.

Laser assisted hatching .

Embryo testing with PGD.

PROBLEMS AT UTERUS LEVEL —

The Uterus—

 

Fibroid ,  Endometrial polyp , endometriosis , Adenomyosis ,intra uterine adhesion , Hydrosalphix abnormal uterine shape like septum , unicornuate uterus and likewise ,

Difficult cervix affecting embryo transfer endometritis ( could be due to repeated  IUI ,  Ascending genital infection , genital TB, etc)

Early rise in progesterone level prior to egg collection in an IVF cycle can cause repeated IVF failure .

Rise in natural killer cell and immune system also can affect IVF success .

How to tackle this problem ?

Hysterolaparoscopy can be useful to know many issues like fibroid , septum , infection etc.

In early  rise of progesterone ln IVF  cycle , freezing and transferring embryo in next cycle can be an option.

PROBLEMS AT MATERNAL & PATERNAL HEALTH–

General and maternal health —

Maternal and paternal health also has an impact on IVF failure. Many portion of this is discussed at various places in this article along with this psychological health also has major impact on IVF  success , psychological health should never be underestimated. Positive attitude many times gives good outcome of IVF  treatment .

Over weight and obesity can cause recurrent IVF failure .

Smoking, alcohol and drugs like cocaine can cause multiple IVF  failure .

Systemic diseases like Diabetes (DM), Thyroid dysfunction , and other Endocrine disorders , blood clotting disorder  can leads to repeated IVF failure.

 

How to handle this problem?

As like all problem this is also not always easy and many times not possible to overcome .

Exercise , diet control, stopping alcohol consumption , quitting smoking , good  blood sugar control , optimum thyroid care , use of enoxeparine type of drugs may sometimes help to overcome this issue .

TECHNICAL PROBLEMS —

Technical problems while doing IVF —

Many factors in this area also need to be addressed

Like

Expertise of person doing IVF.

Expertise  of assistant .

Expertise of Embryologist .

Qualitative and quantitative aspect of medication, lab environment media and disposable  etc.

 

How to tackle this issue ?

Choosing best quality lab and experienced doctors can help at some extent to overcome this issue .

Combinations of these factors some time may play a role .

After all there are many area in the field ART which needs to be studied extensively and research is really needed to find out unexplained causes of repeated IVF failure .

 

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