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 !
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