Sunday, July 12, 2009

Repeated IVF failure - what's next ?

One of the most difficult things IVF patients and IVF doctors need to learn to live with is the failure rate after IVF. For every patient who gets pregnant , there will be at least one who doesn't - and quite honestly , we can never predicted who will be successful and who will not be. So is it just a game of roulette ? Does a patient just have to keep on gambling until she hits the jackpot ?

Unfortunately , sometimes it does seem like that . Human reproduction is not a very efficient enterprise – whether it's being done in the bedroom or an IVF clinic. While we are very good at making embryos in the IVF lab, embryo implantation is still a complete black hole, and we still don't know why every embryo doesn't become a baby.

When the patient has finished 4 IVF cycles and still has not become pregnant even after the transfer of gorgeous-looking embryos , both she and doctor are faced with difficult questions which we unfortunately still cannot answer. The honest answer is that we often just do not know why the embryos did not implant ! However, what we do know is that even embryos produced by healthy young fertile couples have numerous genetic defects , even though they may look perfectly normal under the microscope. Sometimes patients just need to be patient until they get lucky !
However , patients do not want to hear that their IVF specialist does not have all the answers. After spending so much time , money and energy , they feel the least they are entitled to are answers – and an honest “ we don’t know “ just does not suffice.

Desperate situations call for desperate measures. After a failed IVF cycle, doctors are usually on the defensive because one of the things patients may feel ( but fortunately are polite enough to rarely say outright ) is – Did the cycle fail because the doctor was not good enough ? Did the doctor goof up ? And sometimes, the doctor also feels that he has let the patient down.

This is why some doctors will resort to expensive and experimental treatments such as immune therapy, which have been never been proven to work, but are still used widely , because of the great demand from desperate patients.

What is our approach ? We try to analyze the problem scientifically . There are 3 possible variables: the embryos ; the endometrium ; and the embryo transfer. If there has been a problem in one of these areas, we try to figure out whether this was a one-off problem ; or if it is a recurrent problem. Some problems are correctable, and we try to fix them, so that the next cycle as a better outcome. Thus if the embryo transfer was technically difficult because of cervical stenosis , we can transfer the embryos directly into the fallopian tube , by doing a ZIFT. However if the problem recurs , we then need to move to Plan B. Options include : changing the eggs ( donor eggs) ; the sperm ( donor sperm) ; the embryos ( donor embryos) ; the uterus ( surrogacy) - or the doctor !

1 comment:

  1. Balaji7:16 PM

    Thanks Dr. for a good write-up. You speak from your heart and often put yourselves in other's shoes..


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