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17 January 2017

Repeated IVF Failures, Common Causes and Tips to Prevent it

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Written by Dr. R K Sharma
IVF Treatment, though usually successful, can also fail sometimes. IVF procedure as infertility treatment can fail, and here are the most common causes of IVF failure

IVF Treatment, though usually successful, can also fail sometimes. IVF procedure as infertility treatment can fail, and here are the most common causes of IVF failure

Motherhood is a blissful experience no matter the challenges every woman has to go through. This is the reason, IVF treatment or IVF procedure has become a boon for the couples who cannot conceive. But in some cases, there are repeated IVF failures.

1. Common causes of repeated IVF failures:

  1. Uterine abnormalities: Previously diagnosed or untreated abnormalities like uterine fibroid/endometrial polyps/septum, etc. can be a cause for implantation failures.
  2. Poor endometrium: Thin endometrium or poor quality endometrium i.e endometrium with poor receptivity will not be suitable for implantation.
  3. Embryo quality: Chromosomally abnormal embryos or poor quality embryos will face difficulty in implantation, and even if they can, they may not stay for a long time. When the Zona, an embryonic layer present around the oocyte, is thicker than usual, it has been associated with implantation failures, due to the failure of the zona to rupture during fertilization.
  4. Genetic abnormalities in the gametes: Any defect, even minor ones such as chromosomal microdeletions can compromise the quality of the gamete and thus embryo.
  5. Autoimmune diseases: If you are suffering from autoimmune diseases, you might be at risk of recurrent IVF failures. Usually, screening is done in patients with repeated pregnancy losses to rule out Anti-Phospholipid Antibody syndrome, an autoimmune disease.
  6. Other diseases in the mother: Thyroid disorders, uncontrolled diabetes, etc. are conditions that may prevent pregnancy.
  7. Difficulty in embryo transfer: One common cause of failed IVF treatment or IVF procedure failure is the embryo transfer. Problems during embryo transfer or blood seen at catheter tips indicate a high chance of failure in this infertility treatment.
  8. Suboptimal stimulation of the ovaries: This also increases your risk of repeat IVF treatment or IVF procedure failure due to the inability in the production of eggs for fertilization.
  9. Age: Not every teenager or young women will always have regular, ovulatory cycles. Hence to deem such a person as infertile would be incorrect. Sadly, we still encounter women who have been married at an early age and bear the pressure to conceive, although their hypothalamic-pituitary-ovarian axis is not yet stable. And women above 35 years, start experiencing a drastic change in their hormonal levels after infertility treatment
  10. Weight: Don’t just rule out that being overweight causes a high risk of IVF procedure or IVF treatment failure. As women who are underweight can also experience repeated IVF failure.
  11. Overweight/ Obese: The women need assistance with conception because they mainly suffer from PCOS symptoms due to ovulation, or often have miscarriages and higher chances of missed abortions. The hormonal changes lead to being androgenic, which in turn causes poor quality eggs and thus, poor embryos through IVF treatment or IVF procedure.
  12. Underweight/anorexic: Women who are underweight/anorexic/athletes/those doing strenuous exercises, often fail to ovulate due to the decrease in the hormone estrogen. This might lead to absent or irregular periods. Some may present as a variation of Polycystic ovaries.

2. Prevent repeated IVF failures: 

  1. The first thing that must be done is a thorough examination including blood tests and ultrasound. The latter two will especially aid in determining the ovarian reserve.
  2. Thereafter, a laparoscopic hysteroscopy exam must be done to look for and deal with any physical obstacles to conception.
  3. Freshening of the poor quality endometrium is also to be done at this time. And more importantly, a sample should be sent to rule out tuberculosis.
  4. Hydrosalpinges can be clipped at this time to prevent the embryotoxic fluid from causing IVF failures.
  5. Following all this, the correct protocol for ovarian stimulation must be chosen and started.
  6. However, care should be taken that the endometrium is fit for implantation quality and thickness. If not, then it must be supplemented with estrogen till it becomes thick and ready for the implantation and thereafter, in some cases.
  7. Some patients may be given granulocyte-colony stimulating factor injection either intrauterine or subcutaneous, prior to ovum pick up. In women with repeated IVF failure, IV immunoglobulin G when given prior to embryo transfer greatly aids in implantation.

3. What can a physician do: The physician can greatly help in this matter by: 

  1. Dealing with the pre-existing morbidities in the woman such as thyroid disorders
  2. Obtaining the correct BMI to improve chances of conception via IVF treatment or IVF procedure.

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