Sunday, February 20, 2022

Repeated IVF failure versus recurrent implantation failure


These terms sound very similar , but actually they are very different . Let me explain why

One of the reasons for repeated IVF failure is a bad IVF clinic that creates poor quality embryos , because they don’t superovulate their patients well, or because their lab can’t grow blastocysts properly in the incubator . In fact, this is the most common reason why most IVF cycles fail in India , because most IVF clinics don't have the required expertise or experience to be able to create top quality blastocysts. They hide this fact by refusing to share embryo photos with all their patients routinely and proactively .

Treating these patients who have experienced repeated IVF failure in other clinics is actually fairly straightforward , because we just need to superovulate them properly and transfer a single top quality blastocyst to maximize their chances of getting pregnant .

Treating recurrent implantation failure , on the other hand , is much more frustrating . These are patients for whom the doctor has transferred a top quality blastocyst inside a receptive uterine lining, but  3 cycles have failed inspite of doing so.

This is frustrating for both patients and doctors !

The patient wants to know how many more cycles they should be doing, and when they should stop and consider alternative options . When does repeating the next treatment cycle become futile ?

There really is no easy way to answer this question. Statistically , the pregnancy rates increase with the number of cycles patients do , and the cumulative conception rate after three cycles when you transfer top quality blastocysts is about 80% .

Now that doesn't mean that the chances of getting pregnant in the fourth IVF cycle become zero , which is why the patient finds themselves at a crossroads , and needs to make some hard decisions ! Should I change the doctor ? Or should I change the treatment ? This may involve exploring  alternatives such as using donor eggs, donor sperm , donor embryos, or surrogacy.

However, there is often no logical medical basis for doing this, especially when the cycles have been documented to be medically perfect.

The decision is often based on emotions, and we may need to explore alternatives on an empirical basis, to find the one that finally works.

That's why it's important that patients make these decisions for themselves, and a good doctor will emphasize how little we understand in this area . They are honest with the patient , and will let them know that the answers are not clear , because the future is uncertain and unpredictable , and our technology is not accurate enough to be able to identify why top quality blastocysts fail to implant.

 The good news is that options exist , and in fact, we encourage patients to also start exploring non-medical options such as child-free living and adoption.

This way, patients have peace of mind that they have made the right decisions for themselves , because while the outcome is always uncertain, the process itself should be a happy and positive one .

 The only way of ensuring this is by making sure that you explore all the options for yourself , and make your own decisions for yourself . These are life changing decisions and you need to own them , rather than outsource them to someone else , no matter how much expertise he may have.

Remember that doctors are not mind readers , and while they may offer you options, these may not always be in your best interests !

Yes, these are difficult decisions , and you should remember that you will learn from these difficult times , and grow as a person . Yes, this is a deep philosophical truth, and while what patients are really looking for is clear , simple, and easy answers , and a doctor who can be trusted to provide them, it’s equally true that often there are no clear answers in life , and you need to find your own path for yourself.

Need help in getting pregnant ? Please send me your medical details by filling in the form at so that I can guide you !

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