Why IVF Cycle Failed?
The first IVF baby, Louise brown was born on July 25, 1978, until today over 3 million babies have been born using IVF. The ivf success rate was increase dramatically compare to the past. Today patient who undergo IVF cycle treatment are more likely to get pregnant then not.
However there still patient who required 2nd or 3rd IVF cycle. After this initial IVF cycle, every measure needs to be taken to improve the outcome of next cycle. Identification of factors that link to IVF cycle will help.
For normal endometrium to growth and be ready for implantation require adequate blood flow to the underlying spiral vessel, adequate estrogen level and no abnormalities of the uterus such as fibroid and congenital abnormalities. If the endometrium growth is poor then the patient can be treated using exogenous estrogen.
Sometimes the endometrium can be damage due to previous infection traumatic D & C. There will be fibrous adhesion between the uterine walls. This area would have absence of endometrium to prevent implantation. This uterine adhesion and Ashermann syndrome can be easily diagnosed using hysterosalpingogram (HSG) or hysteroscopy.
The adhesion can be removed surgically followed by IUCD insertion to prevent readhesion. However, there are still some patients who have normal uterus, normal uterine blood flow, good estrogen level & yet the endometrium remain persistently. This is because the end organ damage and the endometrium do not response to estrogen in normal way.
For many years it was believed that the best time for embryo transfer is on the 2nd day after egg retrieval. The aim of the embryologist during the embryo transfer is to select the best embryo that has the best chance to implant and develop into the fetus. May of the fail implantation is due to chromosomal or genetic abnormalities of the embryos (some said it is as high as 50%).
The criteria used by the embryologist to select the most viable embryo are which of criteria i.e.; 4 cell embryo, equal size blastomere, absence fragmentation and mono-nucleusity.
Preimplantation genetic diagnosis (PGD) has been suggested to determine normality of the embryo before transfer. However, many studies have shown that PGD cause embryo damage & does not helps to increase IVF success rate. PGD is used in cases where the patient suffers recurrent of miscarriage or the couples have high risk genetically inherited disease which can be diagnosed through PGD.
Another reason of failed implantation is fail hatching. Normally the embryo will hatch through the zona pellucida on day 5. There is thinning followed by the opening of a tiny hole on the zona pellucida which enables to be extruded and implant on the endometrium. AH will help in these patients who have failed.
It is estimated that 30% of female infertility is cause by hormone imbalance of some sort. These patients with hormone imbalance were having irregular ovulation and irregular menses. We can determine your hormone profile by measuring your FSH level, LH level, progesterone on day 21 and prolactin level at anytime.
During IVF cycle, these hormone imbalances can be corrected by exogenous hormone (oral, injection or vaginal route). The most common hormonal imbalance that cause fail IVF cycle is luteal deficiency.
During the luteal phase, adequate amount of progesterone is essential for successful implantation. The progesterone will increase the blood flow to the endometrium, increase the glycogen for improving the embryo, decrease uterine muscle contraction and decrease uterus mobility. The endometrium need to be quinsence. That’s why all IVF cycle require progesterone support either in oral tablet, injection and vaginal pessaries.
The immune system or antibodies in the bodies is designed to protect the women from infection by microorganisms. The microorganisms that enter the body will be attack and neutralized by the lymphocyte or the antibodies that produce by immune system.
The immune system is necessary to control infection. Normally this immune system should not interaction with the embryo which is implant on the endometrium.
In some cases complex immunological interaction take place between the women’s immune cells called NK cell and the embryo, resulting in destruction of the blastomere and failed implantation. There also antibodies that produces from B lymphocyte that circulates in the body tissue and act on this embryo and her own endometrium leading to IVF cycle & recurrent miscarriage.
IVF cycle itself is stress and if there are other events in your life that further add on in this stress then it may affect your immune system, causes imbalance of hormone and increase uterine contraction and endometrium mobility. All these will add up and can lead to failed IVF cycle. Good understanding of the IVF cycle, what to expect in IVF cycle, a good supporting partner will help to decrease your stress level.
Any routine that you have been doing the physically stressful such as aerobic, mountain climbing and long journey traveling should be prevented during IVF because this activities will stress your body system and increase the uterine mobility.
Overweight, smoking and alcohol also affect IVF outcome of the IVF process. Many studies has shown women with body mass index (BMI) of more than 25 have increase risk of miscarriage and failed IVF cycle compared with normal weight women.
Smoking and alcohol also affect implantation of the endometrium by decreasing the uterine blood flow. If you are going IVF treatment you should stop smoking, taking alcohol and control your body weight if you are obese.