Thursday, February 05, 2015

What Can I Do To Make my Embryos Stick?

It’s not hard to understand why patients who have failed their IVF cycle become desperate. It’s difficult for them to come to terms with this failure as most are sure that they would get pregnant in their first attempt. Not many patients would have the courage to start an IVF cycle if at the bottom of their hearts they did not believe it would work for them. When their IVF cycle fails, they begin looking for solutions to increase their chances of success in the next one.

In most cases, patients have good-looking embryos ; and the embryo transfer takes place easily too.  When the cycle fails, it’s obvious the reason is that the embryos did not implant. This is also very grandly referred to as a “failed implantation”. So logically speaking, wouldn’t the simplest solution be to do something that would make them stick? Like some kind of embryo glue that will hold them in place once they have been transferred?

Genetic Causes

Sophisticated doctors might find it amusing when their patient expresses her desires in these simple terms. This is because misconceptions and myths about the IVF process abound. The truth is that most good-looking embryos don’t implant. And we know that a genetic problem in the embryo is the commonest reason for a failed implantation. Even with significant advances in genetic technology (genome testing, array-CGH & next generation sequencing- NGS), this is not something we can easily diagnose.

The Variables

This happens because embryos that seem to be normal on genetic testing might still have lethal genetic anomalies which cannot be picked up with our modern genetic tools. In this context, genetic tests are still in the beta phase and it’s only possible to count the number of chromosomes; it’s still not possible for us to analyze individual genes. Embryo implantation is a complex process that depends on a number of variables. In addition to the actual embryo, the uterine-lining also plays a key role and a range of factors can have an impact on it, such as:

•    Blood supply to the endometrium
•    Hormone receptors on the endometrium
•    Complex crosstalk between the embryo & the endometrium

Self Blame

In many cases, doctors don’t take the effort to explain this to their patients and even in cases when they do, many patients don’t understand it fully well. If their cycle fails, they attribute the failure to something they themselves may have done. What they think is -Maybe lifting something heavy, driving through a cavernous pothole, eating something too spicy or not getting sufficient amount of rest may have caused the embryos to get dislodged.

Hundreds of doubts cross through their minds and many patients don’t get these cleared with their doctors as they don’t want to look “stupid”.  The fact that the internet is choc-a-bloc with myths and misinformation does not help any. We as doctors, keep reminding women that medical science also has certain limitations and we can’t always figure out why embryos do not implant.

When the Truth is Distorted

Some doctors will distort the truth by saying things like- “I made perfect embryos for you. The failure suggests there is something wrong with your body. Perhaps it is rejecting the embryo because you have some kind of immune dysfunction”. For a patient who doesn’t know any better, this “explanation” is plausible enough, even though there isn’t a shred of truth in it. Resultantly, they end up spending a significant amount of time, money and energy on testing these so-called immune dysfunction problems & will also try to get them “treated” in vain.

The Luck Factor

Contrastingly, a conscientious IVF doctor will categorically tell the patient that once the embryos have been transferred into the uterus, they are in no-man’s land. We do our best to facilitate implantation (for example-providing luteal phase support with estrogen & progesterone); but we still can’t control biological processes. The truth is that this is a matter of luck, but patient’s can digest it when doctors use terms such as “fate”, “chance” or “destiny”.

The Natural Course of Things

What they crave for is certainty and if their doctor gives them the bare facts, it upsets them. At times, this also drives them to go looking for another doctor who will mollify then and give them a pseudoscientific explanation for the failure. They are easily impressed with scientific garbage such as the presence of a “pregnancy destroying factor” in their body that needs to be “treated”. The human body still has its secrets and medical science has not been able to unravel all of them.. For the moment, there is no medical procedure that can help your embryos stick and some things have to be allowed to take their natural course.

Not sure why your IVF cycle failed? Want an honest second opinion? Please send me your medical details by filling in this form so that I can guide you better!

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