Another IVF failure story

I got this email from a patient who was at her wit's end.

My reason for Ivf is unexplained infertility. Diag lap& hyst were normal. My amh is on the lower side 2.3. All hormones are normal. Menstrual cycles are regular, perfect 28 days/2-3 days of flow.
No I did not meet the embryologist, the Ivf doc said that out of the 12, they only had 3 embies of 6 cell, grade1-2, with slight fragments on a day 4 transfer.
Iam shocked that at my age I don't even have one excellent quality embryo!!
My 1st Ivf was done in Delhi (step 2014) short protocol, folisurge 150+ menotas 300, stims for 9 days. Retrieved 7 eggs, all fertilised, they do a day 2 transfer at their centre, they transferred 4 embryos of 4 cells grade AB. Cycle negative :(
2& 3 Ivf in Mumbai: renowned Ivf specialist of many years.
Frankly speaking I was never happy with the protocol selection. She used long protocol and stims with menagon 450. I stims for 14 days (2nd Ivf) & 12 days (3rd Ivf).
2nd Ivf: 5 eggs retrieved, 3 fertilised,
3 embryos of 4-6 cells grade 1 with slight fragments transferred on day 3
3rdivf: 17 eggs retrieved, 14 matured, 12 fertilised - and I had only 3 , grade1-2 , 6 cell with slight fragments for transfer!
This doctor advised me donor eggs or surrogate ! I am shocked..
Please help me and give me an honest opinion.

The reason I share these emails I get from patients is to help other couples to analyse the care they are getting more criticially.

Patients are often confused and it's hard for them to find out which doctor is giving them good advice. Did they cycle fail because she has poor quality eggs ? or because the medical care was
poor ?

This is always the million dollar question, and I try to help them find the truth by using a logical framework.

For one, I ask for documentation. I need to see the detailed medical treatment summary as well  embryo photos, before I can provide an intelligent opinion. If there are no embryo photos, then my bias is to assume the care was poor, until proven otherwise. The reason for this is that every good IVF  clinic provides photos routinely and proactively. Not giving these to the patients is a black mark, and a red flag that the care has not been of acceptable standard.

Also, any doctor who tells the patient to use either donor eggs or surrogacy is obviously very confused. These are 2 completely different treatments, and need to be used in very different situations.  This again suggests that the care has not been of good quality, and that improving the quality of care should improve the chances of success.

I am often forced to read between the lines because the documentation is of poor quality, but if a doctor transfers embryos on Day 2, this suggests that they lack confidence in their lab's ability to grow embryos to blastocysts.

Finally , if the doctor transfers more than 2 embryos, this suggests that the implantation rate in their clinic is poor, and they try to compensate for this by transferring lots of embryos at one time, which is poor clinical practise.

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 !