in vitro fertilisation (ivf)

Repeated IVF failures - What's Next? What are the common causes and prevention tips?

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The common causes of repeated IVF failures include poor endometrium and embryo quality, genetic abnormality, increased age and weight, and abnormal uterine activity. To prevent IVF failure go for blood tests, laparoscopic hysteroscopy, immunoglobulin G consumption are advised to the patients.

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.

Main Causes for IVF Failure and What You Can Do:

  1. Common causes of repeated IVF failures
  2. Prevent repeated IVF failures
  3. What can a physician do
  4. What to do after IVF failure
  5. Failed IVF cycle!! When to start again
  6. Treatment Options after a single/ multiple Failed IVF

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.

IVF Treatment

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.

Uncontrolled diabetes

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.

IVF, IVF Treatment

Prevent repeated IVF failures:

  • 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.
  • Thereafter, a laparoscopic hysteroscopy exam must be done to look for and deal with any physical obstacles to conception.
  • 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.
  • Hydrosalpinges can be clipped at this time to prevent the embryotoxic fluid from causing IVF failures.
  • Following all this, the correct protocol for ovarian stimulation must be chosen and started.
  • 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.
  • 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.

What can a physician do:

The physician can greatly help in this matter by: 

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

What to do after IVF failure?

Before undergoing IVF treatment the couple should prepare themselves with the fact that the chances of success are not 100%. There are many reasons that can be the potential reasons for the failure of the treatment.

Age of the patient, quality of embryo, response of the ovaries and the embryo quality etc. are some of the factors that influence the procedure. Many women who fail in their first cycle of IVF, have a good chance of procuring successful results in their second or third cycle. Hence, there is no harm in giving a second try. But there are important steps that you need to keep in mind before going for the second cycle.

  • Factors responsible in the last cycle: The fertility expert should investigate the reasons for the failure of the previous cycle. He should closely examine the result of egg quality, embryo development, the process of transferring the embryo, and if there is no issue with the result if these examinations, then there are good chances of getting the desired result from the next cycle.

  • Preimplantation genetic screening (PGS): should be followed if implantation of the embryo had not taken place appropriately in the previous cycle. It is a genetic test that is conducted on embryos that are derived through IVF. This test enables the fertility expert to obtain information about the genetic health of the embryo and aids in choosing the best embryo that can improve the chance of a successful pregnancy.

Failed IVF cycle!! When to start again?

There is no specific time to start another cycle of IVF after the failure of the first cycle, but it is highly recommended to wait until the cause of prior failure is diagnosed. IVF failure is a big loss for expecting couples thus it is suggested they should go for the second attempt only if they are ready emotionally as well as physically. Failed IVF cycle should be taken like a tutorial so that the chances of failure reduce in the next attempt. Although couple can take their time if they want to take measure for improving their health by altering their lifestyle for some time.

Treatment Options after a single/ multiple Failed IVF

First IVF cycle failed?? It is true that the unfortunate news of failed IVF leave the couples disheartened. But it doesn’t mean the end of hope. IVF is not the last resort, there are other treatment that a couple can opt for considering the responsiveness of the treatment. There are many fertility procedures such as:

  • Intracytoplasmic Sperm Injection(ICSI): This procedure adds to the success of a standard IVF procedure and is usually performed after it is failed once or many times as decided by the expert. In this procedure a single sperm is slected under a high-definition microscope to ensure proper shape, and genetic makeup that make it fit for fertilization. It is then injected into the egg to form a healthy and strong embryo which is of higher quality resulting inimproved IVF success rate.
  • PGD:PGD or Preimplantation Genetic Diagnosis is a screening test carried out on the embryos in an IVF procedure to check for any genetic dosorder that any one or both the parents may have. The test is done on embryos right before the transfer to the uterus for a successful pregnancy and delivery.
  • Egg Donation: Egg donation is a procedure that involves eggs taken from a healthy and young woman to be used for another woman during IVF treatment. It becomes necessary to opt for a donor egg when a woman, due to certain medical reasons, is unable to produce her own healthy eggs that are capable of fertilization. Egg donation program helps such women to continue with the process of IVF without being affectedd by the shortage of eggs.
  • Surrogacy: Surrogacy is a set-up arranged for infertile couples who cannot conceive or carry a pregnancy full term. A woman may have conditions like thin endometrium or a uterine defect or any other related issue that may prevent her from falling pregnant or make her prone to unsafe pregnancy. In such cases surrogacy comes in as a preferred choice where a gestational surrogate is arranged who, through IVF (and donor eggs in some cases) carries the full term pregnancy for the couple. It is however, to be noticed that it is constrained by legal contracts to prevent any complications after the baby is born.

Go through what is IVF and IVF Procedure if you are planning for a baby through fertility treatment. 

Dr. R K Sharma

About The Author

Reproductive Endocrinologist, Hysteroscopic Surgeon Dr. R K Sharma
Delhi

Dr. R K Sharma has completed MBBS and MD in Obstetrics and Gynecology from Pune University in 1981 and 1989 respectively. Dr. R K Sharma is one of the pioneers in the field of IVF treatment in India. He specializes in IUI, IVF, Embryo transfer and Hysteroscopy procedures. He is also a member of Federation of Obstetrics and Gynecology Societies of India (FOGSI). Dr. R K Sharma is presently practicing at Primus Super Specialty Hospital, Chanakyapuri, Delhi. To know more, visit elawoman.com

6 Comments

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Rohit Sahu

Surrogacy should be the last option when you have nothing else left. It is costly as compared with other treatments. My friends chose surrogacy. They got a baby but really spent a lot of money for that.

Nov. 9, 2018, 2:36 p.m. 5.0

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Mr. and Mrs. Chaudhary

We were not able to have a baby then after some tests I got to know that the problem was not with my wife, but it was with me. So we decided to undergo ICSI with IVF. The doctor told us that it will increase the chances of success. After the positive results, we agree that the doctor was right.

April 15, 2018, 9:49 p.m. 4.5

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Sandhya Raghuvanshi

IVF treatment is very effective and 98% successful. It's just that the patient has to first put herself into a healthy body so that the embryo can be nourished properly.

Aug. 26, 2017, 1:22 p.m. 5.0

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Tamanna Singh

IVF treatment takes a lot in terms of money and efforts, it means a lot to prevent its failure.

Aug. 26, 2017, 1:20 p.m. 5.0

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Shrabani Saha

My sister went through IVF treatment and she was overweight. She tried flax seeds and it really helped her. She lost her weight and then tried IVF. Now she is 6 months pregnant.

Aug. 26, 2017, 1:14 p.m. 4.5

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Karishma Kakkar

I have experienced failed IVF cycles in past. Now I will go for egg donation as I am not able to produce healthy eggs.

Feb. 2, 2017, 10:42 a.m. 4.5

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