Monday, December 07, 2015

When bad things happen during your IVF cycle

IVF treatment can be complex and because it involves multiple biological variables, no one can ever be sure what the outcome is going to be and it's possible to trip up at multiple times. Thus, for example, even though the sperm count seems fine and the eggs seem okay, you may end up with total fertilization failure, as a result of which there are no embryos to transfer. Or the doctor may not be able to collect any eggs at the time of retrieval, even though your follicles seem perfect - a condition called empty follicle syndrome.

This can be a major blow, but you need to learn to deal with some of these ups and downs. Your heart can be breaking but you still need to use your head so you can figure out what the next action steps are. There is no point in being emotional about it and getting paralysed into inactivity or cursing your fate - you need to move on.

Step number one is to document everything. Make sure you have copies of your medical records, including photographs of your unfertilised eggs. Step  number two is to think about what went wrong and corrective action can be taken. Sometimes it's possible to fix problem in that cycle itself - for example, by doing an emergency ICSI . Often you have to figure out what you can do differently in the next cycle in order to prevent the problem from happening again.

    Of course , prevention is the best solution, but the reality is that since some of these problems cannot be anticipated, we cannot always prevent them. We need to learn to be able to deal with them if and when and as they occur. Knowledge can be power and if you're aware of all the things which can possibly go wrong, you can think about what can be done in case we do encounter one of those problems. The important thing to keep in mind is it's not the end of the world, and that even if that problem has occurred, there is a lot which can be done - if perhaps not in this cycle, then the next one.

This is why it's so important to have realistic expectations even before the cycle starts. Because we're so worried about the risk of these unanticipated problems, we take an "at-risk" approach and put precautions in place to reduce the risks. Thus, we will routinely do ICSI for our patients, rather than do IVF, so we don't have to worry about the possibility of an unexpected total fertilization failure. Some clinics might think this is overkill, but we think it makes sense. Similarly, in order to make sure that we don't end up with empty follicle syndrome, we follow a set protocol ( for example, doing a urine pregnancy test on the morning of the egg collection to make sure that the patient has taken her HCG trigger shot properly) . All good clinics use techniques such as these to prevent problem.

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