Recurrent IVF Failure

IVF is by far the most effective and successful process which is proven to exponentially increase the chances of you getting pregnant. Although, the incidence of recurrent IVF failure is witnessed every now and then, even in IVF. This may come as a shock to most people as IVF is one of the best infertility treatments. But, at the end of the day, pregnancy is not the simple science as people presume it to be. Many factors decide the fate of conception for an individual, whether it is a conventional or an artificially assisted conception.

What is IVF Failure

Most people can’t really get ahold of the possibility that even IVF can fail sometimes. IVF depends on various factors like your age,  the reason for infertility, the place where the procedure has taken place, whether the eggs were fresh or frozen. IVF failure is due to implantation failure which may be because of many factors. If all these factors favor you, then only you can conceive successfully.

What is Recurrent IVF Failure

Recurrent IVF failure or repeated IVF failure refers to the inability to conceive even after a minimum transfer of four good-quality embryos with three fresh or frozen egg cycles. Not just one but there can be many reasons for it.

IVF Failure Symptoms

There is often a doubt that resides in people’s minds. They want to know if their IVF cycle succeeded or not. There is only one test that we can rely upon, in order to know if the IVF cycle has resulted in a successful conception. A pregnancy test is usually used for checking if someone has conceived or not.  This test is done through urine or a blood test. This test checks and indicates if the level of β-HCG are raised in the samples. The levels are raised in case of pregnancy. 

It can also be indicated by the presence of certain symptoms that usually appear at the beginning of pregnancy. These symptoms include 

• Morning sickness- The feeling of nausea that invites the sense that you are about to vomit.
• feeling tired i.e., in the first 12 weeks, you can feel tired, nauseous, and emotional because of the hormonal changes that take place.
• abdominal discomfort i.e., discomfort i.e., mild stomach pain due to the expansion of the womb in early pregnancy.

Although, the absence of these symptoms does not mean that you are not pregnant as not all pregnancies are symptomatic at the beginning.

The more reliable way to be sure if the IVF failed or not is the diagnosis test. In case of IVF failure, the HCG levels are normal and hence the test shows a negative result for pregnancy.

Causes of Recurrent IVF Failure

If you are someone who is haunted by recurrent IVF failure, you must be wondering why it is happening with you? Well, you may be shocked to know that there are various factors that have significant roles in considering whether you will bear a child or not.

• Implantation Failure of Embryo

As we have established till now, the IVF process is quite complex, and therefore, figuring out the possible obstacle in the way to conception becomes really hard . Most of the time, the cause for recurrent IVF failure or implantation failure is the inability of the embryo to attach itself to the uterus lining. This can happen either if there is some problem with the embryo or the uterus. However, it can’t be accurately determined. Although, most of the fertility specialists assert that over 90% of the embryos get arrested. Many of these embryos die by the fifth day and even the ones which survive and look healthy also, die sometime after being transferred to the uterus.

There are a lot of reasons for these embryos being weak and unable to grow after a certain stage but, as unfortunate as it sounds, there is no way to find out what is wrong with these embryos. Most of the times, the problem can be linked to chromosomal abnormalities which make the chromosomes weak for the IVF. In other cases, the embryos are lacking in the number of cells which makes it unlikely to grow for such cells and therefore, the IVF fails ultimately.

Chances for the IVF can be enhanced  if PGS Testing with IVF is done for studying the genetic content of embryos before transferring them into the uterus. By this method, only the embryos with good chances of surviving will be transferred.

• Quality of the Eggs

The quality of women’s eggs starts lessening from the mid to late thirties. The eggs not only lessen in number but in quality also. Many women don’t know that the probability of their eggs getting implanted reduces to 12% after 40 as compared to the 50% probability at around 35 years of age. Because of this same reason, many women think that their uterus has some problem and hire a surrogate thinking that it would be of some use but doing that also makes no difference as the problem lies in the eggs. Such women can be successful in being a mother if they shift to IVF with donor eggs. In most cases, IVF failure in older women is caused because of older or abnormal eggs as such eggs are not viable.IVF failure rates increase significantly in such cases. Many such recurrent implantation failure success stories have been made possible using donor eggs. 

• Quality of Sperm

Even though abnormality in sperm is not often found to be a cause for IVF failure yet, the quality of sperm is also a very crucial factor for deciding the fate of IVF being a success or not. For the sperm to fertilize the egg, the sperm must be motile. There are also some enzymes present on the head of sperm that break the outer membrane/shell of the egg for the sperm to penetrate and fertilize the egg. Although, sperms are not usually not the reason for the failure of IVFs because the sperms can easily be detected during the process of semen analysis unlike in the case of the eggs, which are really hard to detect. Studies have revealed that incidences of chromosomal abnormalities being found is much more greater in sperms than in eggs. Still, in case of chromosomally abnormal sperm, the fertilization would not take place unlike in case of chromosomally abnormal eggs which lead to abnormal pregnancies.

• IVF Laboratory

The laboratory is the place where simulations are done on how the egg, sperm and the embryo would behave when it is in the reproductive ducts of women. Several factors like the concentrations of the oxygen and carbon dioxide gases, internal bodily factors such as light, temperature, etc are maintained in order to check if the fertilization would take place under such conditions or not. Even minor changes in these things can prove fatal for the embryos. It may sound shocking to many people, but we play with real numbers and possibilities in the laboratory. Proper calculations have to be made before even thinking of carrying out the procedure. So, you should pay extra attention when choosing a consultant. Because, it is not always about the competencies of the doctor but the calculations that are being made in his laboratory also.

• Uterine Issues

The endometrial environment is also an important factor when it comes to IVF success rate. Several elements of a uterus like it’s  shape, presence of any fibroids, polyps, any scarring, or adhesions can result in failure of implantation.

• Maternal and Paternal Health

Not just the mother’s, but the health of the father also is of great significance in an IVF procedure. If the father has deteriorating habits like drinking too much, smoking, or doing other hard drugs, there is a significant reduction that is seen in the possibility of the pregnancy being a successful one. If there are diseases like Diabetes, abnormal body mass index, etc. that can also result in implantation/pregnancy failure. If there are any autoimmune disorders or blood clotting conditions, then miscarriages can also take place.

• Embryo Transfer

The embryo transfer is indeed a non-surgical technique but it is surely one which should be carried on with great sensitiveness. A slight mistake can reduce the chances of success by a significant number. The embryos need to be placed at the right location with the right technique at the right time. Without the carrying out of a trial transfer, this procedure should not be carried out. It is not a job of a quack to carry out this complex procedure.

• Lifestyle

The way a person lives greatly impacts if he can be a parent or not, when it comes to IVF. A person is asked to stop smoking prior to three months at least before the IVF cycle is started. In case of smokers, it is usually twice as harder to conceive even if he/she is using IVF as a help. Even if conception happens, many times miscarriages can be witnessed in such cases. If you are overweight then you would be asked to reduce your weight so that you can maintain a healthy weight. 

Tests Helpful in IVF Implantation Failure

Repeated implantation failure can prove to be a very disheartening matter. But you need to get to the root of the problem for solving it. There are various methods/tests for doing so. 

1. Evaluation of the uterus: The uterus should be evaluated using a hysterosalpingogram (HSG test) before the first IVF cycle itself. It is the only test that properly evaluates the uterus and the fallopian tubes. This becomes a very necessary protocol as we know that most of the time fIVF fails because of certain blockages in the uterus or the fallopian tubes.
2. Evaluation of the sperm: The sperm is examined using the DNA fragmentation test in which the integrity of the DNA is evaluated in the sperm. If there is a high level of segmentation in the DNA while evaluating, then it means there are high chances of the fertilization being unsuccessful or the implantation getting failed.
3. Endometrium Receptivity Assay: As the name indicates this test is usually done for checking the receptivity of the endometrium to the implantation by studying the expression of hundreds of genes in the area. This test is usually done in a normal menstrual cycle of the women. This test can specifically tell us whether the endometrium would be receptive on a particular day for the IVF or not. As this technology works using the genetic markers rather than the biochemical ones, we can get an accurate prediction about the day the IVF could be a success. The day for the IVF can be adjusted successfully.
4. Karyotyping: This is a test done for identifying if there are any genetic problems. In cases of facing recurrent implantation failure or miscarriage, it becomes a very necessary step to check for the chromosomes in both of the parents. This is done to rule out the possibility of any genetic problems leading to the failure. The test is called ‘Pre Implantation genetic Diagnosis(PGD)’. By carrying out this test we can selectively choose the chromosomally normal embryos for transfer and thereby, decrease the risk of any miscarriages or implantation failures creating hindrances in the IVF.
5. Immunological Testing: these tests are carried out for ruling out the possibility of certain autoimmune problems or abnormalities. In case if certain abnormalities being found that simply means there is a hyperactive immune system acting as the main factor for the implantation failures and miscarriages in the case.

This hyperactive immune system is then suppressed using certain drugs and treatments so that it does not act as a hindrance in IVF.

How to deal with Recurrent IVF Failure

Management of recurrent implantation failure is not as easy as it may seem to people. People sometimes wonder “3 failed cycles, what next?” Although, fertility experts believe that it may take upto as much as six cycles of IVF to become successful in some cases. With this being said, we should not avoid the fact that with this repeated implantation failure comes a great deal of emotional pain, which is sometimes even harder than physical pain to bear. 

You have to find some effective coping approaches in such cases for in getting out of this pain:

•  Consult a Fertility Counselor

You should consult a fertility counselor who is licensed and competent. You should be sure that she/he is someone with an objective yet properly informed and justified contribution to bringing to the table. Having such help can really aid you in dealing with the frustration, grief, depression issues that come with repeated IVF failure. A counselor can help you and your partner to maintain love understanding and intimacy in the relationship as sometimes, there is a huge toll that repeated IVF failure can take on relationships.

• IVF Treatment

IVF treatment by far is the most effective method in making your dream of parenthood come alive to reality. But, often people need to use donor eggs or sperms for fertilization in many cases as there may be problems in their own eggs and/or sperm.

• ICSI 

In the case of couples where the male sperm has some quality or quantity issues, ICSI is the best option as in ICSI, doctors filter the best sperm and inject it into the uterus of the female which exponentially increases the chances of fertilization.

• IVF with Donor Eggs

There are several cases with repeated failing IVF cycles when it comes to an advanced maternal age issue or genetic disorders caused due to abnormal genetic factors(chromosomes). In such cases, the quality of the egg can be compromised because of these factors. Considering the use of a donor egg in such cases can be a good strategy to adopt. People can be hesitant when using a donor egg because they think there would be no similarity between the mother and the child as they won’t be sharing the genetic material but fertility centers can find an egg donor with a similar personal and physical profile. This method can be a good way to ensure the success of the IVF as the embryos are conceived from young and healthy eggs.

• IVF with Donor Sperm

There are times when the male has serious fertility issues in his semen whether the reasons are of quantitative(low/zero sperm count) or qualitative(sperm immotility) sorts. In such cases, using sperm from a donor can really bring significant changes to your case and hence, help you in having your baby.

• IVF with Donor Embryo

Like the eggs, there are times when the embryos can be of poor quality, egg reserve count can be below the threshold for trying again or in cases of the male being infertile. You can surely get donor embryos in such circumstances. Embryos can be donated by people who have extra embryos and want to help others in getting the blessing of having a child.

In short, as Dr. Robert Anthony said, “Forget about all the reasons why something may not work. You only need to find one good reason why it will.” 

Success Story after IVF Failure

I am Preeti Agarwal from Agra. I and my husband were trying for many years to have a baby. We could not succeed and, as a result, I was diagnosed with depression. Things became real difficult for my husband who was trying to help me even when he was devastated. Then, a friend of mine suggested us to contact FertilityZilla and God showered us with blessings on us. They told us that we needed ICSI and now, we have an angel of a son.

Conclusion

IVF is a really effective way to get rid of the frustration of not being able to have a child of yours. But, you should also be involved in the process and consider all the possibilities. In case any abnormality that can lead to implantation failure is detected then, the different options for treatment should be considered first like removal of adhesions in the uterus, polypectomy, etc. In cases where the endometrium is very thin and unresponsive then management is quite difficult to do. If the drug treatments like high estrogen doses and progesterone pills don’t work in such cases, surrogacy would be the best option to choose for you.  

FAQs

Why does my IVF keep failing? 

The problem can be any abnormality either in the embryo, egg or even the uterus. Sometimes there are scarring, adhesions, polyps, fibroids in the uterus that can turn the IVF into a failure. 

Why does my IVF fail with good embryo? 

A good embryo doesn’t ensure the success of IVF. The problem can lie in the uterus also. If the uterus has problems like blockages or adhesions, the IVF would be a failure. 

What causes recurrent implantation failure? 

There can be many reasons for recurrent IVF failure like, 

• Male infertility
• Ovaries being polycystic
• Blockages in the tubes
• Problems in the uterus
• Unexplained reasons

How long after failed IVF can I try again? 

It can generally take around 6 weeks of time for the inflammation to (resolve). You should at least wait for a complete menstrual cycle before going for another IVF procedure. Period after failed IVF also takes about at least 12-16 days.

How many times should you try IVF before giving up? 

A large number of women give up the treatment after three to four failures. Recently, a study cleared that the chances increase upto nine cycles. Although, if it is a repeated failure, you should consider shifting to surrogacy. 

Causes of IVF failure with donor eggs

There can be various reasons for failure with egg donors. The major reasons are;

chromosomal abnormality, 

the hyperactive immune system, 

hormonal issues, or 

any infection leading to failures. 

Can a menopausal woman get pregnant with donor eggs? 

Although, after menopause, a woman stops ovulating but that doesn’t mean she can not provide the proper environment for the embryo to grow. There have been many incidences where even 60-year-old women have got pregnant with donor eggs.

References

https://www.sciencedirect.com/science/article/pii/S1472648313004756

https://link.springer.com/article/10.1186/s12958-018-0414-2

https://www.sciencedirect.com/science/article/pii/S001502821200324X

https://link.springer.com/content/pdf/10.1007/s00404-015-3954-0.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4126250/