Thursday, September 27, 2012

The X factor in IVF

It’s very frustrating when an IVF cycle fails. The sad truth is that no matter how good the IVF doctor is , the success rate in a perfect IVF cycle is still not hundred percent. Not only does IVF failure cause a lot of distress to doctors , it causes a lot of anxiety to patients as well ! When the IVF cycle fails, they wonder – Why did it fail ?  Was it because the doctor wasn't competent ? Or is there some other factor at play ? Should we consider changing clinics ?  Patients who have had failed IVF cycles even though apparently perfect embryos were transferred, are understandably upset, frustrated and distressed. They are looking for answers as to why they are not getting pregnant, and are emotionally very vulnerable.

Let’s try looking at this logically. There are basically just two variables which determine if a pregnancy will occur or not after an embryo transfer :
1.    The embryo , which the doctor creates in the IVF lab ; and
2.    The uterus .

If nature were perfect, then logically every time the doctor transferred a top quality embryo into a receptive endometrium, it would become a baby , and the IVF success rate would be hundred percent
( and my life would become much simpler !)  However, most top quality embryos do not implant , even when transferred into a receptive uterus.  This obviously means that along with the embryo and the uterus, there is an additional factor at play. Let’s call this the Factor X in IVF treatment.

Now whether this factor X is the clinical skill of the physician ; or the maternal environment; or the immune system in the endometrium; or just plain luck ( for lack of a more scientific term !) ,  can be extremely hard to determine.  That is the reason I'm labeling it as Factor X - because we don't really know what this is !
Now there will be some doctors who believe that if top quality embryos do not implant , this means there is a problem with the woman's immune system . Their belief is that these women have a defective immunological system ( for example, problems with their NK cells ), which causes them to “reject” these embryos. They will then try treating this with all kinds of immune therapy options , such as intravenous intralipids , lymphocyte immunization therapy and intravenous immunoglobulins .

Other patients believe that the reason their embryos  do not implant is because someone has put a curse on them – and they believe that the Factor X is a curse , which is why they will ask a witch doctor to help them exorcise this. ( Many IVF doctors believe that the quality of evidence which supports a curse as being the cause of IVF failure is at least as good as the evidence which supports a flawed immune system as being the culprit !)

Other patients believe that it’s excessive stress which prevents their embryos from implanting; and they trust that using Mind-Body Techniques to manage their stress will help overcome Factor X.
The reason it’s such a long list is that we don't have any clear way of defining the problem ; and because we can't identify it , we are not very good at solving it . Of course, as time goes by and our knowledge about embryo implantation improves , our ability to be able to decode what factor X is all about will progressively increase , and we will then be able to improve pregnancy rates in IVF cycles.

Meanwhile, we should all just agree to disagree !  The fact that it’s Factor X means none of us know what the right answer is – and it’s okay to follow your gut.



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