We turned to the team at Clinica Tambre and asked them to help us understand why a round of IVF might fail and what would they do for their patients following a failed round.
Let’s start with several reasons why a round of IVF can fail:
Embryo Quality: The quality of the embryo is a significant factor. Only good morphological quality embryos should be selected to be transferred to the uterus. Despite this, not all embryos are viable or have the potential to implant successfully. Embryo quality can be affected by factors such as the age of the woman, the health of the eggs or the sperm. If a good quality embryo is not achieved, is better to avoid an embryo transfer.
Implantation Failure: Even with high-quality embryos, a successful pregnancy requires the embryo to implant into the uterine lining. Sometimes, embryos fail to implant due to issues related to the embryo, the endometrium (which is the tissue inside the uterus), or the interaction between them.
Uterine Conditions: Problems with the uterine lining, such as thinning or abnormalities, can affect implantation. Conditions like polyps, fibroids, infections, abnormal microbiome or scar tissue can also hinder implantation.
Egg Quality: The quality of the eggs retrieved during IVF can significantly impact the success of the procedure. Egg quality tends to decline with age, and older eggs may have a lower chance of successful fertilization and implantation.
Sperm Issues: Problems with sperm quality, count, motility, morphology or DNA fragmentation can affect fertilization rates and embryo quality.
Hormonal Factors: Hormonal imbalances or inadequate response to hormonal stimulation during the IVF cycle can lead to fewer eggs being retrieved or poor-quality eggs.
Genetic Abnormalities: Chromosomal abnormalities in embryos can lead to implantation failure or early miscarriage.
Lifestyle Factors: Factors like obesity, smoking, excessive alcohol consumption, and poor diet can negatively impact the success of IVF.
Medical History: Certain medical conditions, such as endometriosis, polycystic ovary syndrome (PCOS), or autoimmune disorders, can affect IVF outcomes.
Technological Factors: Laboratory conditions, culture media, and embryology techniques can influence the development and viability of embryos.
Unexplained Infertility: In some cases, despite thorough testing, the cause of infertility remains unexplained, making it challenging to predict the likelihood of IVF success.
So what happens next?
Obviously every person is different, and so every treatment plan is personalised, but generally speaking, the first step after a failed round of IVF is to re-check each patients´ situation to see if there is anything that can be improved:
If there are no embryos left over for another embryo transfer and another ovarian stimulation is considered, we can try a different hormonal treatment or a different stimulation strategy to try and improve the outcomes.
If not done before, we can test DNA sperm fragmentation to see if there are further techniques needed for sperm selection before ICSI.
Regarding embryo development, always try to achieve blastocyst stage to have better chances after embryo transfer. If possible, use time-lapse incubators that can give better quality embryos and will let us have more information about pregnancy rates.
Depending on age and on the number of embryos expected, we can add a PGT testing to see if there are chromosomic disorders before an embryo transfer.
If implantation failure is considered, try to investigate other options that could be affecting the pregnancy rates, such as uterine or immunological factors.
If egg or sperm quality are very poor and there is nothing that we can do to improve this, always consider the option of using an egg or sperm donor.
The team from Clinica Tambre will be doing a patients’ meeting on the 29th and 30th of September at TFP Thames Valley Fertility Clinic in Maidenhead. Click here for more information.
Looking after your emotional wellbeing during IVF and how counselling can help
