What to do if you are having repeated IVF failure?

Causes:

In an interview with HT Lifestyle, Dr Asha Vijay, Gynaecologist and Medical Director at GarbhaGudi IVF, listed the factors for repeated IVF failure as –

1. Age: As the woman ages, the functionality of ovaries deteriorates and the quality/quantity of eggs come down.. The embryo quality and the implantation potential becomes very less. In men, sperm damage becomes more as they age and the embryo damage becomes more once the man crosses 40-45 years of age. If the woman is said to be 35 years of age and the man more than 40, there is a chance of implantation failure due to embryo issues caused due to age.
2. In addition, the infrastructure, embryology services and state of the art facilities available at a particular IVF Centre also plays a role. So couples should carefully consider these factors before deciding on a certain IVF centre.
3. History of the patient: If the woman has underlying or a history of repeated surgeries, she is prone to IVF failures. Doctors must analyze the problem and treat the cause.
4. Below are a few other factors –

• Repeated fibroid removal surgery on the uterus
• Repeated endometriosis
• Repeated surgeries on the ovaries
• Congenital anomalies in the uterus like septum.
• If the endometrium does not grow, it could be because of a previous TB infection or pelvic inflammatory disease, no matter how good the embryo is, it cannot be implanted.

According to Dr B Ramesh, Medical Director and Chief Gynaec Laparoscopic Surgeon – Infertility, IVF Specialist and Urogynaecologist at Altius Hospital, the recurrent implantation failure causes are grouped into 3 categories :-

• Decreased endometrial receptivity – could be due to myomas, endometrial polyp, thin endometrium, endometritis, adenomyosis, PCOS, thrombophilia.
• Defective embryo development – could be due to zonal hardening, suboptimal culture condition, poor quality embryos, and genetic abnormalities.
• Multifactorial factors – like hydrosalpinges(problems with fallopian tubes), old age, diabetes mellitus, increased sperm DNA fragmentation.

How many times can a couple opt for IVF?

Dr B Ramesh explained, “RIF (Repeated Implantation failure) definition – failure to become clinically pregnant after the transfer of atleast 3 good quality embryos in 3 fresh or frozen cycles in women under 40 yrs of age.”

Dr Asha Vijay elaborated, “If the woman has good reserves, doctors can try for 3 cycles. If there are enough embryos after the first IVF, then 3-4 embryo transfers can be performed. Few patients would have undergone 6 transfers but it is advised not more than 3 stimulations. Mainly if the patient has had repeated failures. The recent advancements can help detect the exact time for embryo transfer. Usually the transfer of embryo happens at 120 hours of progesterone. The endometrial receptivity assay (ERA) can not only detect when the embryos should be transferred, it can also suspect if the patient is failing because of the displaced window.”

Solutions

Dr Asha Vijay suggested –

• Opt for centres with good facilities, embryo services, and infrastructure.
• Choose technologically and scientifically advanced centres
• Do not merely go as per the rates, discounts and packages that are offered. Spend enough time researching about the centre and talk to other couples who have used the services at a particular centre
• Talk to other couples who have undergone successful IVF treatments
• Read about the doctor and the level of expertise the centre offers.

Dr B Ramesh concluded, “Couple should visit the fertility specialist. We will start investigating the cause for RIF and the majority of RIF cases are idiopathic with no identifiable cause in either partner. Other investigations like hysteroscopy to rule out uterine cavity abnormality, thrombophilia profile, karyotyping of parents, evaluation of sperm DNA fragmentation index, EB for culture of tuberculosis, ovarian reserve assessment.”