The majority of couples take it for granted that conception will happen naturally when they decide to start a family. However, for one in six couples in South Africa, it is not as easy as all that. Most of these couples will need some fertility treatment intervention to allow them to conceive and carry a baby to term.
In Vitro Fertilisation (IVF) is the most successful form of fertility treatment. At Medfem Fertility Clinic we have a 52% success rate per embryo transfer for IVF and ICSI in women under the age of 36. It is very important to note that although IVF success rates are improving all the time it can often take a number of cycles before a patient will see a successful outcome.
A failed IVF cycle is devastating and can bring an enormous sense of loss and frustration. This can bring a lot of stress to couples, and it is well known that excessive stress has a distinct physical effect on the body, including ovulation being disrupted or stopping altogether. It is therefore very important to understand that it is common to undergo an unsuccessful IVF cycle. Failed IVF cycles can also provide information for a successful next IVF treatment. When going into the next IVF cycle, feeling calm and prepared not only makes the treatment more bearable but may well increase the chance of success.
What could be the cause of a failed IVF cycle?
A successful embryo implantation requires a genetically normal embryo and a receptive uterine lining to make a healthy baby.
An IVF cycle can be unsuccessful even with good numbers of eggs (and embryos) if egg quality is poor. Egg quality reflects about 95% of the final quality of an embryo. Poor egg quality, therefore, always leads to poor embryo quality. Embryos from low-quality eggs often fail to implant.
In more than 95% of IVF failures, it is due to the arrest of the embryos. The embryonic arrest is quite often due to chromosomal or other genetic abnormalities in those embryos that made them too “weak” to continue normal development and sustained implantation. Unfortunately, unless we do preimplantation genetic screening (PGS) for chromosomal status on the embryos before transfer, we cannot know if they are likely to be competent.
The endometrium is composed of cells that divide rapidly under the influence of progesterone and estrogen. Since the embryo implants in the endometrial layer, it must be thick and vascular to provide nutrients essential for embryonic development. Ideally, the endometrium should measure at least 9mm in thickness or more. Some women have a poor endometrial lining due to a luteal phase defect (not enough progesterone to stimulate and support endometrial growth), inflammation, invasion of the uterine muscle by endometrial glandular tissue, multiple fibroids, or back-to-back cycles of clomiphene citrate ovulation induction. Treatment with oestrogen and progesterone can alleviate this problem.
Immunologic factors are known to be a cause of IVF treatment failure. Some of the immunologic factors include anti-phospholipid antibodies (APA), antithyroid antibodies (ATA), and most importantly activation of uterine natural killer cells (NKa). Intralipids and other drugs can be used to control these conditions.
Steps after a failed IVF
The first thing that should happen after a failed IVF is to meet with your fertility specialist to review the cycle to understand the various results and establish an estimated success rate for a second IVF attempt. Many issues seen in a failed first IVF attempt can be addressed to eliminate or reduce the likelihood of the same issue occurring in a second try with IVF. At Medfem we analyse the following factors to find the causes of IVF failure:
- Egg Quality
- Sperm Quality
- The stimulation protocol
- Fertilisation results
- Embryo development
- Problems with the embryo transfer procedure
- The endometrium
An unsuccessful IVF cycle, after all the preparations it takes, is often emotionally and financially devastating. We know this well because many of our patients come to Medfem after having failed IVF cycles elsewhere. Our confidence on this issue stems from the fact that we have helped so many patients over the years to conceive, despite long histories of unsuccessful fertility treatments.