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.



3 comments:

  1. Good Post Dr! I am wondering about my X factor now! Embryo, endometrium, immune system, over-thinking (as some accuse me of!),curse, my past life and present life sins,fate?

    What would have happened if I had success the first time around? Might be I will be having a 3-4 year old baby, a happy, struggle free, contended, cozy life? (not for sure, might be!) What happened now after 6 failed IVFS and 2 failed FETs - a strong, resilient, a bit crazy : ) and more empathetic me! Ofcourse happy too! Might be my X factor wanted me to teach some life's lessons : ) Might be it thought I am good student : ) Might be it thought I am a bit special than others : )

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  2. Dear Manju,

    As long as you retain your sense of humour, you'll be fine !

    Dr Aniruddha Malpani, MD
    Malpani Infertility Clinic, Jamuna Sagar, SBS Road, Colaba
    Bombay 400 005. India
    Tel: 91-22-22151065, 22151066, 2218 3270, 65527073

    Helping you to build your family !

    My Facebook page is at www.facebook.com/Dr.Malpani

    You can follow me on twitter at http://twitter.com/#!/drmalpani

    Watch our infertility cartoon film at http://www.ivfindia.com

    Read our book, How to Have a Baby - A Guide for the Infertile Couple,
    online at www.DrMalpani.com !

    Read my blog about improving the doctor-patient
    relationship at http://blog.drmalpani.com

    ReplyDelete
  3. Anonymous11:40 AM

    Dr. Malpani, I found this post right when I'm looking for my Factor X. You nailed it with all the things running through my head. I never had any success with my eggs and at 45 went to donor eggs. We had 4 beautiful blasts and transferred one and froze 3. First cycle BFN. Just finished a FET cycle and again BFN. My mind is racing wondering if this is just bad luck, do I need more testing, my friends in similar boats are swearing by Intralipids, IVIg, LIT and other things. It sucks. I'm scared to go back and get another embryo without more answers.

    How do you feel about the DQa matching? I feel I want more tests before going on but does it really matter then? What about sperm DNA fragmentation even though we did ICSCI and got 4 beautiful blasts? Are these tests wasted money and we just try again? The odds game sucks. Thanks for your blog. It is straightforward and provides great information.

    Marie

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