Saturday, July 10, 2010

After a failed IVF cycle - what's next ?


I just got this email from a patient.

Doctor, I am now at my wit's end ! I have failed 4 IVF cycles at 2 different clinics. The doctor transferred 2 beautiful blastocysts each time ! What do I do next ? My doctor is advising surrogacy, since he believes my uterus is rejecting the embryos.

IVF failure is reproductive medicine's most frustrating problem ! When beautiful embryos fail to implant in a perfect cycle , it's often impossible to determine "what went wrong" ! A knee jerk reflex is to then consider surrogacy.

However, surrogacy is an expensive and complex treatment option, which is best reserved for
women without a uterus. Research shows that the reason for failed implantation is much more likely to be genetically abnormal embryos , rather than a uterine problem.

Just because the embryo transferred was a perfect looking blastocyst does not mean that it was genetically normal ! We still do not have the technology as yet to determine if the embryos are genetically fine. Even though PGD technology is improving, it's still going to take time till it becomes an established part of routine clinical practise. And even if the new PGD technology
( using CGH, or comparative genomic hybridisation , for example) will allow us to check all the 23 pairs of chromosomes, it still only provides a crude check that the chromosomal number is normal - not that there are no genetic defects in the embryo !

Until we can routinely screen all embryos for genetic perfection, the best option is to follow Sutton's Law - to go for where the gold is. If you have failed 4 IVF cycles ( where the embryos looked perfect , the uterine lining was excellent and the transfer was easy), the odds that this is an embryo problem are far more than it being a uterine problem. This is why the chances of success with donor egg IVF or embryo adoption are much higher than with surrogacy.

Of course, most patients want to pass on their own genes to their children, which is why these alternative can be much more difficult options to consider, but they are much easier than surrogacy - and much less expensive as well !
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