Wednesday, March 26, 2014

Malpani Clinic specialises in treating women with failed IVF cycles



Injecção do espermatozóide e retirada da micro...

After a failed IVF cycle it's often hard to bounce back. Even though your head understands that IVF doesn't have a 100% success rate, it's hard to deal with the failure. In their heart of hearts, every patient who starts an IVF cycle believes that this cycle is going to work ! ( If they didn't, it'd be very difficult to even start the cycle ). However , failed IVF cycles are a fact of life and over 50% of cycles will end up as failed IVF cycles, no matter how good the IVF clinic. The failure rate is much higher in poor quality clinics.

Many IVF doctors do not like treating these patients, because they believe they have reduced chances of success. They do not want to tackle such challenging IVF patients, because they may not have the required expertise. Other IVF clinics are worried that treating these patients may reduce their IVF success rate. This is why many IVF clinics will push these patients into doing donor egg IVF, rather than trying to help them achieve success.

At Malpani Infertility Clinic, we specialise in treating challenging and difficult patients. Because we have years of experience, and are very hands-on when doing IVF ( since we do not have any assistants), our success rates even in these difficult IVF patients is high !

After a failed IVF cycle, your hopes go crashing down, and it is difficult to pick up the pieces and carry on living. This is why it's important to give yourself some time and grieve , so that you can bounce back after a failed IVF cycle. Rather than get stuck with thinking about " if onlys " and "woulda, coulda, shoulda" and blaming yourself for the failure, you need to use an analytical framework, so you know what to do next.

Failed IVF cycles cause enormous heartache - for patients and for doctors. Most IVF doctors find it difficult to counsel patients when they have failed IVF cycles.  Many doctors start avoiding patients who have failed IVF cycles, so that these poor patients start feeling abandoned and believe they will never be able to have a baby. 

However, a failed cycle is not the end of the world. Often, it represents a new beginning. Experts like Dr Malpani can learn from the failed cycle, so we can improve your chances of success in the next cycle.

Most patients get stuck in the phase of asking questions to analyse the  failed cycle. Doctor, did I do something wrong ? Did the embryos fail to implant because I did not rest ?

IVF treatment can be stressful, but there's no need to add to the stress by blaming yourself for something which is not in your control.

An unexpressed concern is - Did the doctor do something wrong which resulted in a failed cycle? Patients are often desperate, and will spend hours scouring the internet, to try to find answers to their questions.

Actually, these are very unproductive questions. The quality of answers does depend upon the quality of questions; and after a failed cycle, rather than ask - What went wrong ? or Why did the embryos not implant ? a far more useful question would be - What can we learn from this failed IVF cycle ? And based on this additional hard-earned information, what can we do differently in the  next IVF treatment time to increase our chances of success ?

If it's been a perfect IVF treatment cycle ( transfer of Grade A top quality embryos; trilaminar endometrium of more than 8 mm; and an easy transfer), then often all one needs to do is to repeat the IVF treatment until it works. This requires a lot of patience and fortitude, but human reproduction is not an efficient enterprise, and you don't have a better alternative except to pray and try again.

Several factors may lead to in vitro fertilization (IVF) failure. However, many women who have had a failed cycle will have a subsequent successful cycle which results in a live birth. While not all issues related to IVF failure can be corrected, some issues can be addressed in an effort to reduce the likelihood of another failed cycle. It’s important to understand what factors are involved in each individual situation.

What are some of the things which you can change for the next IVF treatment cycle ?

For example, if your follicles did not grow properly ( your ovarian response was poor ) , you can tweak the superovulation protocol. At Malpani Infertility Clinic, with our years of experience, we are very good at doing this. We can help you grow more eggs, of better quality, based on studying your earlier response. Thus, if you are a poor ovarian responder, we can use the Letrozole Anatgon protocol for aggressive superovulation, so help you make the most of your eggs.

After a failed IVF cycle, remember that it is more useful to change your doctor rather than give up hope . If you have lost confidence in your doctor; or if you find that after the failed cycle, your doctor is not being open or transparent and is not providing satisfactory answers, it's always a good idea to get a second opinion, to confirm you are on the right track ! It's important that you have a detailed treatment summary of your IVF cycle, including photos of your embryos, so an IVF specialist can provide intelligent advise.

Malpani Clinic provides effective IVF treatment programs for patients from other IVF centers who have experienced a failed IVF cycle . Many of our patients come from other IVF centers due to failed IVF cycles. We can help you. We have helped many patients from around the world to have a baby despite previous failed IVF cycles.

What are the other things over which you do have control, and which you can change ?

You can use donor sperm, but with the availability of ICSI, the need to do this is practically zero today. In fact, we use donor sperm only for men with complete testicular failure. While some clinics will blame the poor quality of sperm for a failed ICSI cycle ( by claiming the sperm have high DNA fragmentation or abnormal DNA or abnormal morphology or very poor motility), none of these are issues which adversely impact ICSI fertilization rates in a good IVF lab. No matter how poor the sperm motility or how abnormal their shape or their DNA, in a good IVF lab, fertilization after ICSI is pretty much guaranteed ! Also, once the sperm have fertilized the egg, their task is accomplished. This may not seem intuitive, but boor quality sperm are usually never responsible for poor quality embryos, because embryo cleavage is dependent upon the energy provided by the mitochondria in the egg cytoplasm - not the sperm !

For a large number of patients with extremely poor ovarian reserve, donor eggs is often the best option to maximize success rates.This is especially true for older women. We know that one of the major factors contributing to in vitro fertilization failure is the high rate of chromosomal abnormalities in human embryos.As women age and their eggs get older, the incidence of chromosomal abnormalities in mature eggs increases significantly. The rate continues to increase with advancing age so that by the mid-40s over 75% of human embryos are chromosomally abnormal. This is mainly due to problems with the spindle apparatus in the egg nucleus, which is involved with properly lining up and separating the chromosomes as the egg matures at the time of ovulation. Older eggs have an inefficient cell division apparatus , as a result of which the chromosome pairs do not line up properly and "mistakes" are made when splitting pairs of chromosomes. This leads to eggs that do not have the proper balance of 23 chromosomes and results in a chromosomally abnormal embryo if fertilized. While using donor eggs to "treat" this problem is a fairly straightforward solution, this can be psychologically extremely difficult to come to terms with, especially for young women.

Many women will want to change the uterus when they encounter repeated IVF failure. They believe that their uterus is abnormal, and is "rejecting" their embryos. This reasoning seems logical, but is actually flawed, because the uterus is usually just a passive recipient, and surrogacy does not help to improve pregnancy rates if the woman's uterus is normal.

The trouble is that after a failed IVF cycle, patients want a scientific explanation as to why the cycle failed. They are not happy when the doctor tells them the truth - that it was random bad luck. They demand a diagnosis, because they believe that the doctor needs to accurately "diagnose" the problem, in order to find the right solution. Doctors are happy to trot out a glib diagnosis of "failed implantation" to keep their patients happy - and many will then order a battery of expensive tests to " pinpoint " the cause.

However, "failed implantation " is just a waste paper basket diagnosis, which doesn't provide any useful information. It's just a meaningless label which only describes what happened - that the embryos did not implant, that's all. Unfortunately, when a cycle fails, it's hard to think logically. Patients demand testing, and doctors order these to keep their patients happy.

This wastes a lot of time, money and energy. Even worse, the results of some of these tests come back as abnormal. These are just false positives, which have no clinical importance, but once a result is abnormal, the doctor is then obliged to "treat " it. This wastes even more time and money for the poor patient !

Think about it rationally for a minute. If these tests were really useful, then why would a doctor wait for the IVF cycle to fail before ordering the test ? He would order them before starting the first IVF cycle, if they did in fact provide any useful information.

IVF failures are one of the most depressing experiences a couple can go through in their IVF journey. Having experienced several failed IVF attempts can be very depressing and frustrating, especially when doctors cannot provide a suitable explanation for them. Please learn to be kind to yourself. Often the failure is not in your control.  At Malpani Clinic, we thoroughly evaluate you, before attempting another IVF cycle , so that correctable problems can be ruled out.

This is why, if your IVF cycle has failed, it's important that you have good-quality documentation of your failed IVF cycle ( including photos of your embryos ), so that you can get an intelligent second opinion to make sure you're on the right track !

Please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm so that I can guide you better !




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