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    in vitro fertilisation (ivf)

    In Vitro Fertilization - Reasons For Canceled IVF Cycle and What’s Next

    • 28963 views
    • 4.7   (6 Votes)
    Medically Reviewed by Dr. Deepika Tiwari - MS, MBBS on 11 Apr 2019 - Written by Dr. Meenakshi Sauhta - MD, MBBS, DGO - Grammatically Approved by Dr. Kavita Jaggi Agrawal - MS, MBBS

    IVF cycle gets cancelled when enough follicles are not produced during the stimulation phase, when no quality eggs are retrieved or when retrieved eggs fertilize inadequately. In other words, canceled IVF can occur when women being treated are poor responders to the injections because of high or low estrogen levels.

    In Vitro Fertilization or IVF is an infertility treatment where eggs are retrieved from the uterus and are fertilized with sperms in specialized labs. The fertilized egg is then transferred back into the uterus to allow pregnancy to happen.

    In this article, you can know about:

    1. What does cancellation of IVF cycle mean?

    A canceled In Vitro Fertilization cycle may occur when it is diagnosed during the stimulation phase, that the eggs or follicles are not healthy enough to proceed with the further treatment. A canceled IVF cycle may also mean that there were some issues reported with the embryos before implantation. In this phase, the cycle gets canceled before moving on to the egg retrieval procedure or when frozen embryos are transferred into the uterus. In such cases, proceeding with the treatment can lead to significant health risks to patients. The health risks may include side effects of fertility medications and unrelated illness. There is a high rate of IVF cancellation because of luteinizing hormone (LH) surge and empty follicles. (1)

    2. What are the reasons for IVF Cycle cancellation?

    Based on certain studies, those women who experienced a chemical pregnancy which failed to progress to a clinically approved pregnancy or a spontaneous abortion on their first IVF cycle had more chances of discontinuation than those women whose first cycle was canceled prior to embryo transfer or who did not have a positive pregnancy test after transfer. However, among women who continued to their second IVF cycle, those who had at least a chemical pregnancy on the first IVF cycle had more chances of having live birth on their second attempt than those women who had failed test results before conception in their first cycle. (2) To make room for live birth by the end of IVF treatment, production of at least a range of 3-6 mature eggs is necessary. Too few follicles produced in the fertility stimulation phase can lead to cancellation of IVF treatment. In such cases, experts recommend changes in the treatment protocol by opting different timing, using higher doses, or different combinations of medications. 

    • IVF cycle may also get canceled when the HCG trigger shots are administered at the wrong time. The average time for administering the HCG shots is said to be around 36 hours prior to the egg retrieval procedure. If the injections are given at a wrong time, there are possible chances that eggs may ovulate prior to the procedure and in such cases; eggs cannot be retrieved for IVF treatment. It is important to decide the day of human chorionic gonadotropin (HCG) trigger shot administration in order to get the best mature oocyte. In most of the cases, the day of oocyte retrieval cannot be ascertained as the day of HCG injection depends mainly on the patient's ovarian response to gonadotropins. (3)
    • The IVF cycle may end when follicles are empty. The follicles, which may look good but are empty can create an obstruction in fertilization. Empty follicle syndrome (EFS), although rare, is a medical condition in which no oocytes are retrieved from mature follicle post ovulation induction in IVF cycles. (4)
    • Some women may also pose risks of Ovarian Hyperstimulation Syndrome (OHSS) due to IVF medications or injections. Ovarian hyperstimulation syndrome (OHSS) is excessive after effect of taking the medicines (especially injectable gonadotropins) used to stimulate egg production. In rare cases, OHSS can result from taking other medications, like clomiphene citrate or gonadotropin-releasing hormone. Women suffering from OHSS have a large number of growing follicles along with high estradiol levels. This leads to fluid leaking into the abdomen (belly), which can lead to cause bloating, nausea, and swelling of the abdomen. The severity of OHSS may result in abdominal pain, blood clots, dehydration, shortness of breath and vomiting. Rare deaths are reported. (5)
    • Other than OHSS IVF pose some other illnesses such as a high fever. High fever can affect the temperature of the testicles is expected to be a degree lower degree lower as compared to body temperature. High fever can lead to decreased sperm counts, morphology and motility. Fever can have a lasting impact on the growing sperm in testicles. 

    Sometimes, a new cycle of IVF is suggested for patients who suffered adverse effects of IVF drugs or developed certain permanent medical conditions, which are not suitable for the treatment.

    3. Why IVF cancels due to high or low estrogen levels?

    1. Canceled IVF Cycle Due to Low Estrogen

    Follicles cancel to develop in cases where estrogen levels are lower than expected during the stimulation phase. The low estrogen levels affect the volume of follicles. Low estrogen levels early in IVF pregnancies are associated with poorer pregnancy results. Estradiol may be used alone or in conjunction with hCG levels to determine the odds of live birth. (6)

    2. Canceled IVF Cycle Due to High Estrogen

    The cycle may also get canceled due to high estrogen levels. The fertility drugs used in IVF treatment can cause a rise in estrogen levels. High estrogen levels can lead to ovarian hyperstimulation syndrome (OHSS), which if left untreated can cause complete loss of fertility. Several published research papers have shown that extremely high levels of estrogen at the time of embryo transfer can increase the risk of life-threatening condition, preeclampsia and the chances that babies born would be smaller for their gestational age. In such cases, when the estrogen levels for patients undergoing IVF exceed 4,500 pg/mL on the day of administration of trigger shot, the cycle is either canceled or postponed. (7)

    4. How to go through egg retrieval with few eggs?

    For women who have a condition of diminished ovarian reserve and women who want to avoid the risks of OHSS, can opt for mini - IVF treatment where few follicles are required. There are chances that women may have repeated canceled conventional IVF cycles if they have a condition of developing a few follicles. Women diagnosed with diminished ovarian reserve and don’t want to go with a donor egg, can opt for mini - IVF treatment.

    5. What to do after IVF Cancellation?

    After having a canceled IVF cycle(s), first of all, a mental preparation of having 100 percent results should be wiped off the mind. Many patients have successfully conceived after canceling their first IVF cycle and many others have canceled in their second attempt as well. There are many reasons on which the success and cancelure of an IVF treatment rely such as endometriosis, ovarian cysts, unexpected rise or drop in estrogen levels and high progesterone levels. After canceling an IVF cycle, your fertility expert may change the pattern of infertility medications. In cases where none of the eggs fertilized, IVF with additional treatment such as ICSI is advised. In other cases, adoption or IVF with donor eggs or donor sperm is advised to patients.

    6. IVF with Donor Eggs

    Even after experiencing multiple IVF failures, another successful option can be IVF with donor eggs. For women who canceled almost all the chances of becoming pregnant with IVF cycles, undergoing IVF with donor eggs can prove to be successful for having a baby. Donor egg is considered to be a cost-effective procedure than adoption method. The primary indication for egg donation was originally the women who were diagnosed with premature ovarian failure (POF), called menopause occurring before the age of 40 years. Going by the research, POF affects approximately 1 percent of the female population and this condition indicates depletion of a woman’s own eggs and cessation of ovarian function. Women suffering from diminished ovarian reserve but with intact ovarian function are also considered to be the candidates for IVF with donor eggs. It has long been known that women who have crossed the age of 40 years or more have notably reduced fertility in general, and a poorer chance for success after IVF. Other potential indications for IVF with donor egg may include: women having previously failed multiple IVF attempts, particularly when poor egg quality is suspected, and women having transmittable genetic abnormalities, which may affect their offspring. (8)

    It can be concluded from the facts above mentioned that people still have alternatives to go with after having multiple canceled IVF cycles. One can opt to restart the treatment or cycle with variations in IVF medication process or patients can go for adoption or IVF with donor eggs. Those who want assistance with any of these treatment queries can reach elawoman.com or can talk to the fertility experts at +917899912611.
     

    Dr. Meenakshi Sauhta

    Written by

    MD, MBBS, DGO
    Gynecologic Surgeon, Laparoscopic Surgeon
    Gurgaon

    Dr. Meenakshi Sauhta is a reliable infertility specialist and laparoscopy surgeon, who provides high success rate in infertility treatments. She has rich years of experience in the field of Gynecology and Infertility Treatments. She is also an expert in Tubectomy, Hysterectomy, Fibroid as well as Cyst Removal. She completed her MBBS and MD from MGIMS under Nagpur University in 1988 and 1994, respectively. She also completed her DGO from the same college in 1990. She is well-known for providing high success rate in infertility treatments as she incorporated modern tools and technology in her practice. She is a highly qualified infertility specialist and a valued member of the Maharashtra Medical Council, Haryana Medical Council, and Indian Medical Association.
    Dr. Meenakshi Sauhta has trained in reputed hospitals under the guidance of talented professionals and is currently working at Max Hospital in Gurgaon. Furthermore, she has received many awards and recognition, some of which are presented by world-renowned organizations. She was elected President of Gurgaon Obstetrics and Gynecological Society In 2013 and was an editor in ObsGyne Update Journal of Gurgaon Society. Dr. Meenakshi Sauhta also received recognition as a super trainer in Adolescent Health Care in IMA Headquarters. She also stood as an Executive Member in Indian Medical Association, Gurgaon. Owing to her three decades of excellence in infertility treatments she is registered under 61102 of Maharashtra Medical Council, 1989 and 3920, Haryana State Medical Council, 2009. She presently associated with Max Hospital in Gurgaon.
    Max Hospital is one of the top fertility hospitals of Gurgaon. The team of doctors at the hospital has treated over 5 lac patients across 25 specialties like Cardiac Sciences, Minimal Access and Laparoscopic Surgery, Urology, Orthopedics, Aesthetics, Neurosciences, and Reconstructive Surgery and Nephrology. The hospital also has a huge accommodation facility with well-furnished and clean rooms. The hospital has state-of-the-art health-care facilities including endoscopy unit, Radiology and pathology diagnostics and other support specialties. Max Hospital strives to give its patients a personalized treatment with full compassion and care. Moreover, The hospital provides the best Pregnancy care and fertility services as per the requirement and budget of patients across different parts of India and world.

    SOURCES AND REFERENCES:

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    6 Comments

    user_img

    Priyanaka Sambhavi

    IVF has helped me in becoming a mother. It is one of the best infertility treatments. My doctor said that there might be some complications but eventually, it was successful.

    Nov. 26, 2018, 6:11 p.m. 4.5

    user_img

    Prachi Sharma

    I got my IVF cycle canceled due to high estrogen levels. The doctor said that it will lead to a failed IVF cycle so it is better to cancel it now.

    Nov. 25, 2018, 9 p.m. 5.0

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    Raunak R Bhargav

    My wife's IVF cycle was canceled because of the low volume of follicles. Now she is being treated for this problem. We just pray that after this we will get a successful treatment.

    Nov. 22, 2018, 12:20 a.m. 4.5

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    Fatima Sultana

    After three failed IVF cycles I got success in the fourth attempt. There were some complications because of which every time the results were negative. I am happy that finally, it was successful. Now I am pregnant and hope to see my baby soon.

    Nov. 21, 2018, 10:21 p.m. 5.0

    user_img

    Riddhima Gahlot

    The most important factors that affect the success of an IVF cycle are age, quality of the embryo and ovarian response.

    Nov. 20, 2018, 3:56 p.m. 4.5

    user_img

    Surabhi Devi

    My IVF cycle got canceled because of very thin endometrium lining. I am on medication to improve my lining.

    Nov. 19, 2018, 8:22 p.m. 4.5

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