I actually wrote this post last week on the train from Dublin, and took it down the next day, for some reason I havent been able to write the words that make sence to me about this topic. So today, I sat down and forced myself to rewrite this blog. I suppose sometimes we are in the moment and other times we are not. So here goes… 🙂 I think for me, the hardest consults are the ones just after one of my patients has found out they are not pregnant from their IVF cycle. What do you say, what can you say, how do you take away the sadness, move the anger, and support their fear of will it ever happen for them. I know that they have done everything possible, improved their diets, reduced their stress levels where possible, taken their medication religious around the bruises on their bodies from the injections. And finally they get to egg collection and transfer of their amazing wonderful beautiful embryos.

Crawling through the two week wait. Final, the test date arrives, the day where life holds a deep breath for the two minute wait. Its not a positive result. Their world, hopes for the future, hopes for having a child all fall apart within seconds. I just really can’t ever understand what that feels like, I see it ever week in their faces, but truly I don’t feel it. Only they know.

It is a devastating time. Leaving the question “what caused our IVF to fail, why us?” Its a question I wish I had an answer to, a magic wand to answer what will never be answered.

A few years ago, I was at a fertility conference where the consultant was extremely honest and just answered, its nature, we just can’t control all the aspects of life or nature. And the more time I work in this area, the more I realise how little we actually know. Even with all the techology, the medication, the acupuncture, we sometime just dont know. The most common reasons however are broken into:

The Quality of an Embryo

The quality of an embryo is determined by just two factors, sperm and egg, the basic ingredients of life. If these two factor are in any way not optimal, then it can lead to issues of development and growth. Unfortunately too many times, clinics will focus on egg quality and dismissing the sperm factor. They believe they only need to get one sperm, dismissing the potential quality issues of that one sperm. We do know that the development of a mans sperm is usually 90 days. I personally believe anything that he does over this 3 months will have a potential impact. Both positive and negative. We deal alot with male factor, recently we had 4 cases where sperm counts were less than 8 million, well below the minimum numbers of 15 million and over 4-5 months have all improved to over 45 million, with one of the mens counts going over 70 million. Now that is a massive massive change. Think of it like driving your car to work at 7 miles an hour and then 4 months later driving to work at 70 miles an hour it really is a massive difference. Of course these results don’t improve for all men, if its a physical blockage, trauma or hormonal imbalance then unfortunately they won’t see much change in their numbers.

Egg quality is much harder to improve but there are still lifestyle changes that can improve the quality. Lifestyle is a big one, but again it depends on all factors being equal, AMH results, Age and hormonal balance.

Poor Ovarian Response

There are times where some women just don’t respond well to the medication, its almost like the body kicks back and say no. More and more clinics are now looking at the AMH test as a way to evaluate how well a woman will respond to the medication during her IVF cycle. In Ireland its still a relatively new result and there have been plenty of times where AMH says one thing and then when the clinics do a scan the ovaries respond completely differently. I find it ironic that a test created for evaluating menopause is now determining how quickly a couple should do IVF. And personally, I think its being used as a scare tactic by some clinics. I’ve seen here in clinic how devastating it can be to a patient if the results come back aren’t good. The one thing I would say though is that AMH should be seen more about Ovarian Recruitment than Ovarian Reserve, and just because you increase the dosage of medication doesn’t mean it will improve the response, there is a tipping point with stimulation. Typically women with high FSH or low AMH don’t respond well, but thats not necessary a negative thing, if this is the case, then focusing on improving the quality should be the main goal. I will always take quality over quality.

Implantation Failure

The uterine lining is one of the most important final parts to the jigsaw, its where implantation occurs. After all the meds, all the scans a wonderful beautiful healthy egg is retrieved, we have some super sperm and all is ready to create an amazing embryo. Now only implantation needs to happen. Unfortunately, in my experience this is one of the most common reasons for an IVF cycle failure, the clinic will have done everything in its power to develop as many follicles as possible, find the best possible sperm for the fertilisation, taken care of the fertilised embryos for a few nights and then transfer the most amazing embryos available. However, what they can’t do is predict the quality of the lining, the environment that the embryos will settle into.

Polyps, cysts, poor blood flow, thin lining, all contribute to an embryo not implanting after an IVF transfer cycle.

The Age Factor

Age has been the number one target for the cause of an IVF cycle failure, for many years, it was believed that it was determined by a womans age, now we know better, the mans age is as important, if not even more. There is little we can do or change about the age of our patients undergoing an IVF cycle. But what you can do is take care of you, spend 3-4 months before your cycle looking after yourself, with exercise, diet and lifestyle changes. There is so much you can do to improve your chances here.

Autoimmune Issues

This is possible the most controversial of all reasons, today we have a 50-50 split with OB/GYNs as to whether this is a cause. Some doctors will say absolutely no, it is not an issue, others the opposite, most definitely a concern. More and more tests are being developed to establish if it is a cause. This is basically where the immune system destroys an embryo before it can establish an implantation, all the way up to 8 weeks of a positive pregnancy. There are immune therapy approaches that will help implantation to occur, but again, theres a 50-50 split as to whether these are a viable approach. But its definitely something you should consider talking to your doctor about if you have had 3 or more failed IVF cycles or have experience 2-3 miscarriages in a row.

There are lots of other reasons as to why an IVF cycle fails, but these are the most common, if you’d like more information on this, please don call me anytime. Gordon.