Tuesday, March 22, 2016

Why did my IVF cycle fail? What went wrong, Doctor?


I just had a chat with a patient where we had transferred perfect blastocysts into her uterus with a perfect endometrium. She hadn't got pregnant so she was obviously concerned and wanted to know - What went wrong doctor ? Did I do something wrong which stopped my embryos from implanting ?

I told her that just because the IVF cycle had failed did not mean that anything had gone wrong - and that the word wrong itself was the wrong word to us. It's an emotionally charged term, which is very judgmental. It suggests that the reason for the failure was that either something was wrong with the medical treatment ; or that there's something wrong with her uterus or  her embryos.

The reality is that implantation is often a matter of luck. I agree luck is not a very scientific word , but not everything in biology can be dissected, explained or controlled, and the sooner we learn to accept this, the better for everyone ! However, this requires a lot of maturity, and counseling is extremely important . Patients need to to accept that the IVF success rate is not 100%, that while we can control some variable to improve their chances of success, once we have transferred the embryos back into the uterus , we have no control over the implantation process. This is why patients need to do their homework, so that they have realistic expectations before they start the cycle.

We always do an analysis for every IVF cycle , but we don't wait to do it until after the beta HCG is negative. We do a premortem, at the point of the transfer , because this is the final checkpoint , over which we still have some control. After this, we have no ability to predict or manipulate the fate of the embryo , which means there is no point in doing any further analysis , because we still cannot open this black box. After transfer, everything is guesswork, and speculation about the final outcome is quite pointless.

At the time of transfer , we check the endometrial thickness and texture; we check the quality of the embryos , and show them to the patient; and we make sure that the embryo transfer went smoothly. If all these three things are fine, then we tell the patient that their IVF cycle went off well. However, this doesn't mean that they will get pregnant in this cycle, no matter how much we would all love for this to happen !  The good news is that if the cycle has progressed well, this means that we have been able to find the right medical formula for you. After this, it's just a question of being patient and repeating the cycle, until you finally get lucky !

This requires a lot of maturity and discipline on the part of the patient. However, it's important that patients don't start getting desperate or frustrated , and they should not ask the doctor to change the treatment protocol just because the first cycle has failed. Playing the woulda, coulda, shoulda game just adds unnecessary stress to your life, and doesn't improve your chances of getting pregnant !

Need help in getting pregnant ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !



 

4 comments:

  1. Anonymous11:00 AM

    Hi Doctor, How many IVF cycles should one go through before they give up on the treatment, opt for surrogacy or adoption? Too many medications that too hormonal may have its side effects.

    ReplyDelete
    Replies
    1. There are no medical risks in doing multiple IVF cycles; and the major risk is financial and emotional. When to stop or move on to Plan B is a decision only the patient can make, and depends upon how each cycle progresses

      Can you send me more details about your IVF cycles ?
      DO YOU HAVE PHOTOS OF YOUR EMBRYOS ?

      You can see what embryos should look like at http://www.drmalpani.com/knowledge-center/ivf/embryos

      What were the meds which were used for
      superovulation ? What was the dose used ? How many follicles did you grow ? How many eggs were collected ? What was the E2 ( estradiol) level in the blood ? What was the endometrial thickness ?
      How many embryos were transferred ?
      What was the embryo quality ?
      Can you please send me the printed treatment summary from your IVF clinic ?

      We look forward to helping you to have a baby !

      Delete
  2. Hello doctor. I have just had a cancelled GET cycle die to fluid in the endometrial cavity. The fluid came 4 days after I had begun progynova. We cancelled they cycle and did a hug and a hysterocopy . The his showed one to be patent and the other had a corual black. There was no fluid coming from them. They also did a hysterocopy and send a sample for biopsy together with 5he fluid. All tests came back normal. I do now on day 8 of my second one FET and after 3 days if progynova the fluid is back. I am so frustrated about this situation. Can you please advise me? Thank you

    ReplyDelete
    Replies
    1. I agree this is unusual

      Maybe you can do your FET in a natural cycle ?

      We look forward to helping you to have a baby !

      Dr Aniruddha Malpani
      Malpani Infertility Clinic, Jamuna Sagar, SBS Road, Colaba
      Mumbai 400 005. India

      Clinic Mobile: 9867441589

      Tel: 91-22-22151065, 22151066, 2218 3270, 65527073

      Helping you to build your family !


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

      You can add a google review for us at https://plus.google.com/102706636605134081909/about


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


      Delete

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