Reason for IVF failure
Cycle cancellation prior to egg retrieval due to insufficient follicle production;
No eggs are retrieved, or only eggs of poor quality are retrieved;
Recovered eggs either do not fertilise or fertilise insufficiently.
There is no embryo accessible for implantation into the uterus.
For a variety of reasons, transferred embryos may not implant.
And, of course, no pregnancy will result from embryo transfer.
Failure as a result of insufficient ovarian stimulation
Another issue that we notice in failed IVF cycles is that patients are not given an ovarian stimulation strategy that is appropriate for their “ovarian age.” The reason for this is that stimulation protocols are frequently selected based on a patient’s age. Younger women, on the other hand, may suffer from undiagnosed premature ovarian ageing (POA), in which their ovaries behave “older” than they should for their age. Those ovaries must then be stimulated in the same way that the ovaries of an older woman are—a detail that is sometimes forgotten. Patients must be given ovarian stimulation regimens based on their ovarian age, not their physiological age, for successful IVF treatment.
Poor Quality Eggs and Embryos
Even with a large number of eggs (and embryos), an IVF cycle can fail if the egg quality is poor. The quality of an egg reflects approximately 95% of the eventual quality of an embryo. Poor egg quality always results in poor embryo quality. While sperm quality is crucial, it is not nearly as important as egg quality.
Embryos derived from low-quality eggs frequently fail to develop normally. During an IVF round, embryos are monitored in the lab for 3 to 5 days before being placed in the uterus. Good-quality embryos should be at the 6-to 8-cell stage and have a more or less regular shape by the third day. Embryos that do not reach this stage within the first few days of development can not be transferred. Furthermore, some embryos that reach this stage may be aneuploid (have chromosomal abnormalities). If aneuploid embryos implant, they frequently miscarry early in the pregnancy, resulting in “failed” IVF.
As a result, as many of our patients are already aware, it is not only the number of eggs that is crucial. The quality of the eggs is also important for IVF success. In this setting, the formation of dehydroepiandrosterone (DHEA) in DOR women becomes critical. Our initial discovery was that DHEA supplementation boosts IVF pregnancy rates, particularly in women with DOR. However, we have confirmed that DHEA supplementation enhances egg quality, embryo quality, and lowers aneuploidy (chromosomal defects) in embryos over time.
Our physicians have been able to accomplish previously unfathomable results by using DHEA in conjunction with a well-designed IVF procedure for each patient: women with a long history of failed cycles and/or very low ovarian reserve are conceiving in considerable numbers, and with their own eggs!
Use of Preimplantation Genetic Screening (PGS) or PGT-A in an Inappropriate Manner
Preimplantation genetic screening (PGS), also known as preimplantation genetic testing for aneuploidies (PGT-A), has been a fairly common reason for IVF cycle failure in recent years. PGS/PGT-A has been heavily marketed by testing laboratories to IVF centres and fertility patients without sufficient evidence that the test improves IVF outcome parameters, and CHR has been vocal about the harm it causes patients, particularly those who do not produce a large number of embryos to choose from.
We’ve had far too many patients come here after undergoing PGS/PGT-A at other facilities, when all of their embryos were found to be “abnormal” and their IVF cycles were terminated without embryo transfers. Given that over a hundred healthy births have occurred in the last few years following transfers of embryos labelled “abnormal” by PGS/PGT-A, these patients may have had a fair chance of delivering healthy infants. While PGS/PGT-A may have a use in a very restricted number of situations, practitioners typically urge patients not to undergo this costly yet untested test.
Unknown Causes of IVF Failure-Possible Autoimmune Involvement
Perhaps the most frustrating IVF failures are those for which no obvious cause can be established. Autoimmunity (immunity against oneself) in female patients is a component that is frequently neglected in investigations.
The impact of female autoimmunity and excessive inflammation on reproduction has been debated among IVF experts, but evidence in the published literature suggests that even subclinical autoimmunity (autoimmunity that does not require medical treatment and is not clearly visible) can have a negative impact on fertility. The experts in immunological infertility warn that autoimmunity should always be investigated when repeated IVF failures appear to have no cause. Patients with autoimmunity are treated with a variety of immunological infertility treatments to keep their autoimmune under control. This has resulted in numerous successful in vitro fertilisation births in women who had previously failed IVF due to autoimmune issues.
Researchers were able to demonstrate a genetic marker for autoimmunity in 2010, which presumably affects the chance of conception with IVF significantly. This study was published in the prominent online medical journal PLoS ONE. Autoimmunity appears to be far more significant in developing a successful reproductive treatment plan than is commonly recognised.
When IVF Cycles Fail, What Should You Do?
Even if everything goes according to plan, from ovarian stimulation to egg extraction to embryo implantation, a significant number of women will not receive a positive pregnancy test. Overall, IVF pregnancy rates have increased dramatically in the three decades since the procedure was first launched, but it is still far from flawless. Negative pregnancy tests are still prevalent, especially among women with DOR (whether due to natural ageing or early ovarian ageing), and patients who want to work with their own eggs must expect it to take more than one cycle to conceive.
The crucial question is whether we can improve on failed cycles. In our weekly conference, we review and deconstruct every IVF cycle that did not result in a pregnancy. This is the only way to improve. The treatment alternatives that other centres can not provide, as a fertility centre that has been pushing the boundaries of fertility treatment for the past three decades.
Assisted Reproductive Technology (ART) Using Donor Eggs
One of the most crucial things to realise about IVF treatment is that it only works approximately half of the time, even in the best of circumstances. As a result, the patient may require numerous cycles to become pregnant and deliver a child. A woman who is older or has “premature ageing” of her ovaries, on the other hand, may not have a successful IVF cycle.
Patients may choose to use donor eggs in these circumstances, which are not uncommon because of our specific expertise in treating women with ovarian ageing. Donor IVF allows a woman who would otherwise have no chance of becoming pregnant to carry and birth her own child using her husband’s sperm. Adoption is frequently less expensive than donor egg cycles. We also have an embryo adoption programme that has proven to be extremely successful. Book your appointment with Dr. Kaushiki Dwiveedi who is the best ivf doctor in Gurgaon.