Monday, February 20, 2017

Have you failed many IVF cycles ?


Patients who have failed multiple IVF cycles are extremely frustrated. They are their wit's ends, because everything they have tried has failed so far. They are desperate enough to try to clutch at straws. They are willing to explore many different options, including changing  multiple IVF  clinics. They are willing to be treated as guinea pigs, and will subject themselves to painful and expensive tests, in the hope that they will  find the success which has eluded them so far.

When you are confused, it's very helpful to start from first principles. Begin from the basics, by making a list of all your possible options, so you can think through them logically.  Remember that along with medical options, you also have non-medical options, and it's always worthwhile exploring these in parallel.

For now, let's just focus on what your medical choices are. You need to remember there are only four variables in an IVF cycle, and you need to decide which variables you're comfortable with tweaking and changing.

Thus it's possible to change the eggs; the sperm; the uterus; and the doctor.

If there is a problem with the eggs, you could use donor eggs ; and if  there is a problem with the uterus, you could use surrogacy. Unfortunately , patients often get very confused because there are so many variables. The trick is to change  just one at a time - and it makes sense to change the one which is likely to give you the best results.

Thus in this day and age with ICSI, it's very unlikely that the sperm will be a problem. This means there's very little need to use donor sperm , no matter how poor the sperm count is , or how abnormal the sperms are, or what the sperm DNA fragmentation level may be. This is why it ultimately boils down to choosing between changing the eggs or changing the uterus - either donor eggs or surrogacy. This choice often confuses patients . Most feel that if the embryo did not implant, this means that their uterus has " rejected " the embryo. This is why the majority intuitively believe that there's something wrong with their own body, and that surrogacy would be their best option. Sadly, doctors  are also quite happy to perpetuate this myth, because surrogacy is so much more profitable for them. And if the surrogacy cycle also fails ( as it usually will, because the problem was never with their uterus in the first place, but with their poor quality eggs), then patients are deluded into believing that at least they tried the most advanced option medical science had to offer them . They are then forced to reconcile themselves to the bitter fact that they will never have a baby, but the biggest tragedy is that they never even realise that they were led down the wrong path by their doctor !

Similarly , if they miscarry after an IVF cycle, they feel it's their uterus which is to blame; and their doctor explains that they have high NK cells or some " embryo-toxic factor " which prevents the embryo from implanting . However, this is not true.  In pregnancy, a useful rule of thumb is that the seed is active and the soil is passive. If you do need to change something, it's far better to consider using donor eggs rather than to use surrogacy.

This has been proven  many times. This is the reason why an older woman's fertility declines - not because there's a problem with her uterus, but because her egg quality takes a beating as she ages. Even if she produces embryos and transfers these into a surrogate, the chance of that cycle failing or miscarrying remain extremely high.  Remember that there never was a problem with her uterus in the first place !  Poor quality eggs result in poor quality embryos , which in turn result in failed IVF cycles or failed pregnancies.

If you are confused, the best option is to change your doctor . Getting a fresh second opinion will help you explore all your options more intelligently, and give you peace of mind you tried your best !

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 !






1 comment:

  1. Hi had two failed cyvles and one that ended in a miscarriage. I just had a transfer sunday. Niw I am so worried this wont work. Tonight, my apartment was hot and I ipened a heavey long dresser drawer to get a shirt out. Coukd this have damaged the embryos?

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