Thursday, August 27, 2015

When Embryos Refuse to Implant

It’s normal for patients who have failed an IVF cycle to be desperate. It can be very difficult to come to terms with this failure. Most IVF patients don’t consider the possibility of failure and they feel that one attempt will be enough to give them the baby they want. But when their cycle fails, they begin looking for solutions to up their chances of success in the next one.

Most of the patients will have had pretty good embryos as well as an easy embryo transfer; when a cycle fails, it means that their embryos didn’t implant and this is what most call a “failed implantation”. So, logically if the embryos have failed to implant, the one way to change the equation will be to find ways and means to make them stick- maybe some sort of embryo glue will do the trick and ensure they stay where they are meant to be?

Genetic Problems Lead to a Failed Implantation

Sophisticated patients and doctors might find it quite amusing when a patient expresses her desires in these simple terms. This is because many people still have a number of misconceptions and myths about the entire process of what actually happens to the embryo once it is transferred into the uterus. The truth is that a large percentage of good looking embryos don’t implant. We also know that in most cases, it’s a genetic problem in the embryos that results in a failed implantation.

It’s also a fact that this is something we can’t really diagnose, even with the highly advanced genetic technology such as whole genome testing, array CGH and next generation sequencing (NGS), that we have access to today. This is simply because embryos that appear normal on genetic testing might still have certain anomalies that we are unable to pick up.  Despite all the advances, we are only able to count the number of chromosomes via genetic testing; we can’t really analyze individual genes using these tests.

A Complex Process

When it comes to the complex process of embryo implantation, there are a number of variables in play. Apart from the embryos, the uterine lining has a key role to play too.  In turn, this is affected by a number of complex variables such as:

Blood supply to the endometrium
Hormone receptors on the endometrium
Complex crosstalk between the embryo and the endometrium

The problem stems from the fact that most patients don’t understand these technicalities and doctors don’t bother to explain them to the patients. The latter believe that it’s something they themselves did wrong that dislodged the embryos from their uterus. The different things they think of are:

Maybe I put  too much pressure  on my uterus by lifting a bucket
Maybe driving through that large pothole caused my embryos  to fall out
My diet may have been too spicy
I probably  didn’t rest enough
Other  ( you can fill in your own favourite reason here)

As myriad possibilities run amok in their head, they are unable to find straight answers. To a certain degree, they feel that their questions and doubts are stupid and they abstain from getting these cleared from their doctor. Misinformation and myths abound on bulletin boards and this just adds fuel to the fire.

An Immune Dysfunction?

It’s important that doctors help their patients understand that science has its limitations and we don’t really know and can’t begin to explain why embryos don’t implant. Some doctors distort the truth, telling their patients that the implantation failure is an indication that something is wrong with the patient’s body and that an “immune dysfunction” is causing it. With this as a premise, multiple tests will be ordered and a significant amount of money will be poured into identifying these purported problems and then on “treating” them too.

Sure, all of this seems very sophisticated, but these tests are nothing but a whole load of hogwash and have no basis. Contrastingly an honest doctor will categorically tell his patient that once they have transferred the embryos into the uterus, it is essentially in no-man’s land and that biological processes cannot be controlled by any doctor, no matter how competent he is.

The Wrong Vocabulary

But then words like “luck” and “destiny” don’t fit into a doctor’s vocabulary, and patients don’t want to hear it from them either; and the unvarnished truth is something that many patients can’t digest. It’s sad that patients will very willingly believe things like they have a “pregnancy  destroying  factor” that will require treatment before they will be able to conceive (which is what some doctors will tell them), and they get caught in this unending  and unnecessary  cycle of tests and treatments that they find  difficult  to yank themselves out of .

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