Why does IVF fail?

Friends, family, and the internet have all told us about the effectiveness of in-vitro fertilisation (IVF) procedures. However, we don't often hear about unsuccessful IVF, owing to the fact that it's a very emotive subject for those who want to be parents. This blog post aims to dispel the taboo and discuss some of the reasons why IVF may fail.

When it comes to patients who do not have a clinical pregnancy or live delivery, there are a variety of causes for their IVF failure.

Age of the Female

The quality and quantity of a woman's eggs decreases as she gets older. It's common knowledge that as women age, they have a lower likelihood of becoming pregnant; nevertheless, a decrease in egg number and, more importantly, quality, also decreases the chances of a clinical pregnancy or live birth following IVF treatment.

Quality of Embryos

The female's eggs and the male's sperm are combined together in the laboratory portion of IVF treatment with the goal of generating an embryo. Embryos may appear healthy in the laboratory, but when implanted into the uterus, they may fail to implant due to an undetectable abnormality. Our IVF lab grades the quality of the embryos and selects the best to return to the uterus using a scoring system.

Ovarian Response

The female is required to inject a fertility hormone called follicle stimulating hormone (FSH) daily at the start of IVF treatment in order to boost egg production. Some women's ovaries do not respond to this medicine properly, and as a result, they do not generate enough eggs for harvest. Due to the already limited quantity of eggs in older women, this is especially true (low ovarian reserve).

"If you have a poor ovarian response, it doesn't imply the IVF treatment is over," Dr. Malpani adds. Investigations and medication changes may be able to help improve the issue. A blood test for Anti-Mullerian Hormone (AMH) and an ultrasound scan of the antral follicle count are used to determine ovarian reserve. The optimal protocol and dose of hormone to stimulate your ovaries and produce a respectable number of eggs would be determined by your ovarian reserve."

Problems with Implantation

This indicates that the embryos did not successfully implant in the uterus. This could be due to the existence of uterine polyps, a premature spike in progesterone levels, a thin endometrial lining, or a uterine infection. "If an embryo fails to implant, it is not your fault," Dr. Malpani adds. "Most of the time, implantation complications are beyond anyone's control." We assemble a complete set of tests to rule out any potential causes of implantation failure."

Abnormalities of the Chromosome

IVF can fail due to chromosomal abnormalities in the embryos. This indicates that chromosomal DNA is missing, excess, or irregular in the embryo. The embryo is then rejected by the body, resulting in IVF failure.

Why Does IVF Fail? : How To Avoid Repeat IVF Failure

It may take two or more IVF treatments to obtain a successful pregnancy. While this can be physically, emotionally, and cognitively draining, knowing that you are not alone in your struggle, that support is available from fertility professionals with decades of experience, and that IVF failure is not your fault may be comforting.

Your doctor will advise you on what caused the failure after each round of IVF and how to use this information to improve your chances of success if you decide to try IVF again.

Priyanka Chopra and Nick Jonas welcome first baby via surrogate

Priyanka Chopra and Nick Jonas announced the birth of their child via surrogacy on Instagram.

Priyanka Chopra and Nick Jonas jointly shared a photo on Instagram that read: "We are happy to announce that we have welcomed a surrogate baby into our family. We sincerely request that you respect our privacy during this important time so that we can focus on our family."

Neither of them has revealed the gender of their baby, but according to TMZ, the surrogate gave birth to a girl last Saturday.

Chopra, 39, expressed her and Jonas' wish for children in an interview with "Vanity Fair" just a week before the pair made their joyous announcement.

"They're a significant part of our future aspirations," the "Quantico" star said. "By God's grace, things happen when they happen."

Chopra has been married to Jonas, 29, for three years. They married in a lavish three-day wedding in India in 2018.

Although she has a "busy" schedule, the Bollywood diva said in March 2020 that having a family is "extremely essential" to her.

"It's something I certainly want to do, and I'm hopeful that it'll happen whenever God wills it, at the proper, opportune time," she told Tatler magazine at the time, echoing her Vanity Fair interview.

It is inspiring when our Indian celebrities battling infertility, openly talk about barrenness and how they overcome this obstacle. There are lots of stigma and myths related to IVF & Surrogacy that has to get answered and stories like these give hopes and positive message to people who wanted to embrace parenthood.

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

Why we specialise in treating patients who have failed IVF cycles in other clinics.

Patients  who have failed an IVF cycle are very different from those who are doing their first IVF cycle .

When you start your first IVF cycle , you are full of hope and optimism . You know that IVF has a high success rate , and is the one medical treatment which maximizes your chances of having a baby.

Most women start IVF with the expectation that they will get pregnant in the first cycle itself.

After all, if you didn’t secretly believe this, you wouldn't have started in the first place.

 Also, IVF doctors add to this false hope. The doctor you do a consultation with in an IVF clinic is extremely optimistic , because they are in sell mode , and want you to sign up with them for your IVF treatment. That is why they promise you the earth and the moon, and praise themselves and their high success rates.

 This is why you are sure that your first IVF cycle will be your last as well, and you are extremely optimistic that it’s going to work – especially when the doctor tells you that your embryos are "top quality " and is very hopeful at the time of the transfer.

 This is why most first-time IVF patients are poorly informed . They don’t really know what an IVF cycle entails, and are pretty much willing to accept whatever the doctor tells them at face value,

 They fail to do their homework , and get carried away by the misleading claims of 70% success rates that many IVF clinics claim on their websites.

 This is why, when their IVF cycle fails, they go to pieces. They come to their senses because this is their first rude brush with reality . They are extremely angry and unhappy, and will blame the doctor for the failure.

 Also, since most IVF clinics are only interested in maximizing their profits, they would rather spend their time and energy on marketing and attracting patients for their first IVF cycle, rather than talking to those who have failed an IVF cycle.

 Patients who have failed an IVF cycle are very unhappy and angry , and they will vent their ire on the doctor, because they need someone to blame. It’s no fun talking to an angry patient, which is why most doctors will avoid them and refuse to take their calls.

 The patient feels cheated and abandoned , because this is adding insult to injury.

Ironically, high-end brand-name IVF clinics see failure as an opportunity to make even more money.They advise the patient to do a battery of expensive and complex tests - and the patient wonders if these are really necessary, because they have lost faith in the doctor.

After all, if the tests were useful, why didn’t the doctor do them before starting the cycle ? Why did he wait for the cycle to fail before advising them ?

They feel let down and confused.

These are the patients whom we enjoy treating, because it’s only after failure that patients understand the importance of Information Therapy !

They wake up, and start doing their homework – a little late, perhaps, but better late than never !

They then understand what global good practices are – and this allows them to appreciate the difference between an expert doctor , and someone who just makes a lot of tall promises on their website .

These are the patients we are very good at treating, because we're very open and transparent , and take pride in being answerable and accountable to patients, and educating them , so that they know exactly what to expect.

We highlight the importance of doing only blastocyst transfers,  and making sure they have photographs of their embryos, so they can have peace of mind that they've received high quality treatment , no matter what the outcome of the cycle may be. This is when they realise that the reason for their IVF failure was a bad IVF clinic !

 If you’ve been unfortunate and have failed an IVF cycle in another clinic and are not sure what to do next , please reach out to us, and we'll be more than happy to help , because we are a boutique, highly specialised IVF clinic that focuses on dealing with challenging patients who have been let down by other clinics because of poor quality treatment.

 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 !

 

Why are IVF clinics so scared of growing embryos to the blastocyst stage in the lab ?

Why are IVF clinics so scared of growing embryos to the blastocyst  stage ? Many IVF clinics come up with all kinds of flimsy excuses and pretexts for transferring embryos back into the uterus on Day 3, especially when the patient has only a few follicles and a few eggs .

This is to cover up their incompetence, because they are scared that the embryo will not develop  to the blastocyst stage in their IVF lab, because they don't have enough confidence in their embryologist. This is why they pressurize the patient to transfer the embryo back into the uterus as soon as possible . This way, if it fails to implant , they can blame the patient’s poor endometrial receptivity, rather than accept responsibility for the fact that their lab was not good enough to make a good quality blastocyst.

The reality is that it makes no sense to transfer Day 2 or Day 3 embryos into the uterus , because the day 3 embryo doesn't belong in the uterus - it belongs in the fallopian tube . An embryo reaches the uterus after spending about 5 days in the fallopian tube, which is why all embryos that are transferred into the uterus should only be Day 5 embryos.

Now I understand the patient’s concern. You are worried that if your embryo arrests in vitro in the lab and doesn't become a blastocyst, you will end up with no embryos to transfer , which means your chances of getting pregnant will be zero .

That is a perfectly valid worry , but also remember that if your day 3 embryo doesn't become a day 5 embryo in a good laboratory , then it’s not going to become a Day 5 embryo in your uterus either. This embryo would not have implanted, no matter what.

Now if your IVF lab is not good, then you should kick yourself for having paid good money to take treatment in a bad IVF clinic !

Good IVF clinics are very confident about their ability to grow embryos to blastocysts routinely , irrespective of how many embryos they have to start off with .

Let’s assume the worst, and suppose your embryo does arrest in the lab. You will be broken-hearted in the short term, but this way you have gained invaluable information as to what the problem is , so that you can come up with more intelligent solutions for your next cycle . This way, at least you know what to do differently in the next cycle. You will also end up saving yourself from a fruitless and pointless 2ww !

Keeping on transferring Day 3 embryos cycle after cycle means you will end up wasting a lot of time, money and energy , and the only person who will benefit from your repeated failures is the IVF Clinic.

This is why it's so important that you be well informed about IVF treatment. If your doctor refuses  to grow your embryos to the blastocyst phase, this in itself is a red flag , and you should worry a lot about why they are reluctant to do so. Often, the truth is that they know their lab is incompetent, and want to hide this fact from you.

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 !

Unexplained infertility is easy to treat !

 

One of the commonest diagnoses we make for infertile couples is called unexplained infertility. 

Patients get very upset with this diagnosis , because they believe that if the doctor cannot find out what the problem is , then either he is not a good doctor because he seems to be groping in the dark, or even worse , he will not be able to find a solution. After all, don’t you need a diagnosis so you can prescribe the right treatment ?

This is why, when a patient gets a diagnosis of unexplained infertility , their first step is to get a second opinion from a new doctor , and the new doctor orders an entire battery of tests . He repeats the old ones ( because he doesn’t trust the earlier labs), and adds many more, most of which are extremely expensive , because he wants to show off to the patient that he is very thorough and experienced, and knows a lot more than the earlier doctor.

The truth is that all these expensive tests don’t provide any useful information . In fact, they actually end up creating more confusion , because the doctor is going on a hunting expedition, and is looking for problems to find. However, most of these new tests haven't been clinically validated , and "abnormal " results mean nothing, because many fertile couples will also have abnormal results ( but because they have enough sense not to go to a doctor, doctors are blissfully unaware of this fact).

If your diagnosis is unexplained infertility , you should actually be happy – this means that your eggs, sperm, uterus, and tubes seem to be normal ! This is far better than having a zero sperm count (azoospermia), or blocked fallopian tubes !

The truth is that all tests have certain limitations , and our technology cannot answer all the questions that doctors and patients ask.

For example, while our tests ( HSG and laparoscopy) can tell us if your fallopian tubes are open , we can't tell you whether they are working properly or not . We can check anatomical patency, but not physiological function. 

Just because we can't answer that question doesn't mean that there is any point in running more tests ! No matter what the results of these additional tests may be , this doesn't change any of the treatment options we can offer you , which is why there’s no point in doing them at all.

The quality of an answer depends on the quality of the question , and the question really shouldn't be - Why am I not getting pregnant ? A far better question is - What should I do in order to get pregnant ?

Unexplained infertility simply means that your eggs and sperm are not meeting in the fallopian tube when you have sex in the bedroom , and we cannot determine the reason because of the limitations of our testing technology.

The good news is that we can increase the probability of the eggs and sperm meeting, either by doing IUI, or by doing IVF ( if IUI fails).

A basic rule in medicine is that before agreeing to do any test , you need to ask your doctor: how will the results of the test change my treatment options ? And if the test results aren’t going to lead to any actionable information, then don't let the doctor do the test just to satisfy his curiosity !

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 !

Why I get upset when my patients don't ask questions !

 

IVF patients often complain that doctors are not willing to answer their questions .

It’s true that many doctors get upset when patients ask too many questions . What’s even worse is that they get even more upset when patients are forced to go to Google to find answers to their questions because the doctor refuses to answer them !

This is why patients often bottle up their questions , or suppress their doubts . They hope that the doctor will do what is required, and treat them properly.

However, I get upset when patients don't ask me questions !

I remind them that I am not a mind reader , and that if you ask me questions , I can answer them . However, if you don't ask me questions , I don't know what you are worrying about , and I will not be able to help you reduce your anxiety levels .

In fact, I ask patients questions during their IVF  treatment all the time,  and I get upset with patients who can't answer them. This means they haven't done their homework , and will most probably have unrealistic expectations of what I can do for them – something that is not good for either me or them.

Asking questions during your IVF treatment - and getting answers from your doctor - reduces your anxiety levels .

The truth is that the outcome of any IVF cycle is going to be uncertain , no matter how well it goes. All we can do is ensure the process itself is a happy and positive one , so that patients have peace of mind that they received high quality medical treatment from a good doctor , who took good care of them.

However, the only way you will know this is if you ask questions , and get answers .

However, don’t expect your doctor to spoonfeed you. You should do your own homework for yourself , so you don’t pepper your doctor with questions that you can easily answer for yourself by doing a search online .

The only stupid question is the one you don't ask , so make a list; try figuring out the answers for yourself from reliable websites; and then ask the doctor the ones that stump you.

It’s important that you spend enough time doing some homework , so you can learn to differentiate between reliable websites and unreliable websites , so you don't get confused by Dr Google , and don't get taken for a ride by bad doctors .

This is why we provide so much information about IVFfor free on our website and our YouTube channel, so that patients can behave as well-informed, partners during their infertility journey and we can help them achieve their goal of completing their family.

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 !

Or you can WhatsApp us at https://api.whatsapp.com/send?phone=919867441589&text=Hey!%20DrMalpani

For how long can I safely postpone having a baby ?

 

This is a common question which plagues many 30 year old professional women.

They have a number of questions about their fertility. They want to know when they need to start worrying about their biological clock; whether they should accelerate their search for Mr Right; if they should prioritise becoming a mother over pursuing a career; or if they should explore the option of freezing their eggs.

These are complex questions . While we know that every woman has a biological clock , and that as you get older , your ovarian reserve gradually gets depleted because you start running out of eggs until you become menopausal , and that this decline is irreversible, the trouble is that it's hard to know for an individual patient what her personal ovarian reserve is – and women only care about their personal situation – they don’t care about statistics.

The truth is that there is a difference between your chronological age and your ovarian age, and while you could be the fittest 38 year old woman in the world who can run a marathon without breaking into a sweat, this doesn't mean that your egg quality is good enough to allow you to make a baby .

Many women get confused , because they feel that if they are physically fit , this means their ovaries will also be fit , and they will be able to have babies as long as they continue having regular cycles .

Sadly, that’s not true, and this can come as a rude shock, when you realize that your eggs are good enough to produce enough hormones to lull you into a sense of false security, but not good enough to make babies.

The good news is that it's now possible for an individual woman to accurately measure her personal biological reserve . You need to do a simple blood test called the AMH level ( Anti-Mullerian Hormone) , which you can order for yourself at the local pathology lab.

While this is a good test that is inexpensive and easy to do, interpreting it correctly can be quite tricky.

For women who are more than 30 and who want to postpone childbearing ( which seems to be the norm across the world for highly educated, ambitious women who want to have their cake and eat it too ) , the good news is that you don't have to sacrifice your career because you have taken time out to have a baby .

You need to make well-informed  decisions for yourself, and the best way of doing this is by measuring your AMH level every year on your birthday, once you turn 30.

This will provide you with a very useful trend as to what is happening with your ovarian reserve, because we don’t treat numbers – we treat people.  The trend will give far more reliable information about your fertility, and how it is declining as you grow older. If the drop is rapid, you may want to consider arresting your biological clock by freezing your eggs , so that you can later on have a baby using those frozen eggs.

These are complex decisions , and you need to make them for yourself ! If you make well-informed decisions , you will be able to follow the path of least regret , because you will have peace of mind that you used technology intelligently, and selected the path that was right for you.

This way, you can ensure that biology doesn't become destiny, as regards your choices about building your family !

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 !