Why IVF Fails
When IVF Fails…
There are few things more sad than a failed IVF cycle. However, when a failure occurs, a careful evaluation will almost always provide the answer. We need to ask the question “why IVF fails”. Sometimes it is just bad luck, but we never assume that’s the reason. Every aspect of the cycle must be evaluated. Every aspect.
Much of the work we do at G5F is dedicated to helping patients with failed IVF cycles from elsewhere. Initially, the first thing that needs to happen is to obtain all the outside records for review (and this may require weeks). Using your records as a starting point for review, here are some of the questions we commonly ask to assist us in developing a new better treatment plan for you:
Were you (and your partner if applicable) assessed fully and correctly?
Were the Fallopian tubes assessed? Are they normal?
Were all aspects of the uterus assessed? Are they all normal?
Do any underlying metabolic issues exist which may impact egg quality?
Was the treatment protocol optimized for greatest egg quality?
Was the protocol followed carefully?
When and how was ovulation triggered?
Was the sperm normal?
Was fertilization normal? If not, why?
Was embryo development normal? If not, why?
Is there evidence of problems in the IVF laboratory?
Were the embryos tested for genetic abnormalities?
Was the embryo transfer easy?
Were the embryos placed in the uterus correctly?
Was there pain or bleeding after the embryo transfer?
Was the timing of the embryo transfer appropriate?
What type of protocol for the embryo transfer was used?
What type (and dose) of supplementary progesterone/estrogen was used?
Are there roles for additional testing of sperm, eggs or uterus?
What is the reputation/quality of that IVF center?
Sometimes there will be more than one issue requiring correction going forward. For example, the gonadotropin stimulation protocol and ovarian response form a crucial part of our review. But so will sperm quality and fertilization effectiveness.
Certainly anatomic factors, immunological factors, and imbalances in the blood clotting/clot dissolving system can also adversely affect embryo implantation. Yet, the most critical parameter that impacts the IVF success rate tends to be the competency of the egg. Put another way, in many cases the age of the ovary is the single biggest factor influencing reproductive outcomes with IVF.
Genetic testing of the embryo(s) transferred is essential as well. There can be significantly high rates of genetic error in embryos even when the eggs come from anonymous donor eggs. Even donors under age 30 who have previous pregnancies of their own may have high rates of abnormalities. In one study, fewer than 50% of embryos derived from donor eggs were chromosomally normal. In other words, many embryos can be genetically abnormal even when the age of the ovaries is very low (as with egg donor IVF cycles). Thus it is critical to assess the genetic quality of all embryos.
Even in high quality IVF labs, an exceedingly important cause of IVF failure relates to genetic errors in the embryo(s) transferred. Abnormal embryos are more likely to undergo developmental arrest and fail to implant. Genetic problems in the embryo cannot be accurately evaluated only by grading or scoring of their appearance (“morphology”). This is why we recommend that all patients have their embryos assessed using Preimplantation Genetic Screening (PGS) prior to beginning an embryo transfer cycle.