Why IVF Fails
Why IVF Fails?
Whenever a couple walks in with an IVF failure the most usual question is “Doc, we were told all is fine, then why did my IVF fail?”
Before answering this question there another question comes first.
What is IVF?
IVF or in-vitro fertilization is a process in which both egg and sperm are collected from the individuals and then mixed outside of the body in laboratory under suitable environment to make proper fertilization.
After fertilization occcurs the embryo is then transferred into mother’s uterus after 2 days of fertilization.
The best IVF centres and fertility clinics in Kolkata like Care IVF follows this principle of in vitro fertilization to achieve the height of IVF success rate in Kolkata.
It is found that IVF success rate is 40% after the first attempt.
Let’s try and analyze the reason for this failure. Success depends on good quality eggs, decent sperms, a uterine environment, controlled hormonal factors and some degree of luck.
Eggs: Most IVF specialists would agree that egg quality is one of the most important determining factor for IVF success. While this depends on age of the lady, sometimes young women have bad quality eggs while an older woman would have much better quality eggs. We base our primary evaluation of egg quality on AMH and AFC (Antral Follicle Count) values. Sometimes we do prime the couple based on these values that their eggs are good or bad, but ultimately when the oocytes or eggs are recovered and observed under microscope, our initial evaluation may have to be changed. We have to understand that somewhere our job is that of a narrator whose informs you of the progress of the case as is seen through his eyes. I have had patients who get upset when having been told that they had a good AMH are later told that they did not good quality eggs after egg collection. Egg production we have seen is dependent on many factors and one of them is stress during the IVF cycle. The same patient given the same drug and dosage in two different IVF cycles may have diametrically opposite response.
Sperms: The advent of procedure of ICSI or Intra Cytoplasmic Sperm Injection they say has almost abolished Male Infertility. Yes that’s true in one way named ICSI infertility treatment but it’s also true that a sperm sample with low count or low motility is also likely to have sperms with abnormal shape and poor genetic material. These sperms produce fewer embryos and because in ICSI we humans and not nature select the sperms to be used, the chances of embryos having genetic defects are more. There is a test called DNA fragmentation that we employ to find out which samples have gross genetic defects that may require samples to be taken directly from testis or from other donors.
To know more about the ICSI infertility treatment you can go through http://www.careivfkolkata.com/Treatment/ICSI
Embryos: While a good embryo obviously comes from a good egg, there are some finer nuances we need to consider. Even in a young woman, 20-30% of the embryos may have genetic defects while in an older woman or a woman with poor AMH, 50-75% embryos may have genetic defects. Such embryos are naturally filtered by the body are not allowed to attach to the womb or in some cases, may attach but may not grow beyond a certain point (what we call a biochemical pregnancy). The question you may ask is, why not test for this genetic defect and then transfer. Yes of course we can but then it entails an additional cost of more than a lac of rupees which in the Indian context would not be cost effective. If the test is not done, it means more embryos being frozen and more frozen embryo transfer cycles being undertaken but ultimately when a normal embryo meets the womb, implantation will automatically happen.
Uterine: The uterus is normally triangular shaped. In some women because of the presence of an overhanging projection from the roof (called a Septum), or a Polyp, the embryo may not attach at the right place or may be rejected due to inadequate blood supply. Such women benefit from a Hysteroscopy (discussed elsewhere on the website) and correction of the problem. Sometimes we also find infections lurking in the lining which need to be removed before a successful pregnancy can happen.
Hormonal Factors: There are various factors like uncontrolled thyroids, anti thyroid antibodies, anti phospholipid antibodies, vit D levels, Prolactin levels which influence the success or failure of an IVF cycle. Needless to say, such conditions should be mandatorily checked before even proceeding for the 1st attempt.
Luck Factor: There are many factors we still don’t know. That’s the reason why IVF successes worldwide have not gone beyond 40%. I commonly give the example of a newly wedded couple, in that even if they were to come just after their marriage and want an IVF directly, there would be no guarantee that it would click in the first attempt. Why even the best of embryos don’t attach to the womb, why sometimes, not so good embryos attach well and give us a pregnancy? There is a definite dialogue which is initiated between the embryo and the lining of the womb. What constitutes this dialogue and what influences it, is something yet unknown.
I hope I have been able to provide some clarity on the issue and not further complicate it. What I can tell you is that IVF has been around since 1978 and millions of babies have been born with its help. There is no reason why you can’t be among them….. it just requires a bit of faith and patience.
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