In-Vitro Fertilisation or most commonly known as IVF is the most preferred treatment for couples that face fertility issues and have a hard time getting pregnant. With the impressive advancements in assisted reproduction technology, IVF can be combined with other treatments to enhance results and increase success rates even more. Unfortunately, while it has helped millions of couples around the world conceive and give birth to perfectly healthy babies, it does not always deliver the desired results.
Although we have taken significant steps forward, towards understanding biological events such as a pregnancy, there is still much we do not know about the wonderful but complex mechanisms which take place inside the human body. However, what we do know as of now, is enough to cover many of the whys that swirl inside a patient’s mind, and provide some answers. Today, we will talk about what could possibly have gone wrong with your IVF treatment, especially when everything seemed to be going just fine and a healthy embryo was implanted into your uterus giving you and your doctor the impression that you are on the right track, or what can play a role in the result of an IVF treatment leading to IVF failure.
Biological Reasons Why IVF Could Fail
1. Egg Abnormality
First of all, you are definitely NOT to blame for an unsuccessful IVF cycle. Among the plethora of unknown factors that are required for a successful pregnancy, we know that we need a healthy egg, a normal functioning sperm (which will create a healthy embryo), an embryo-welcoming uterus, and an immune system that will accept the implanted embryo.
But, let’s first things first. When we combine a normal egg with a normal sperm in the laboratory, we initiate a process where cells that carry the DNA chromosomes divide to create more identical cells. With each divide, the DNA containing in them is also transferred to the new cell, bearing the same number of chromosomes. On day 3 or 5, depending on the case, the number of cells have given form to an embryo that continues to grow and is ready for transfer. When the chromosomes are wrongly distributed, we have an abnormal embryo, although it might appear normal under the microscope. This means that the embryo in nonviable.
One of the most common reasons why this happens is because the structure that allows chromosomes to divide (spindle apparatus) breaks. And, that is directly associated with the patient’s with age. It is evidenced that 90% of normal-looking embryos in women over 40 have the wrong number of chromosomes as opposed to the 30% of embryos of women in their early 30s that have chromosomal abnormalities.
How Can we Fix it: Unfortunately, we can’t intervene int his case and correct this issue. What we can do, though, is determine the number of the chromosomes in a day 3 or day 5 embryo with extremely high reliability thanks to a new method called PGS or Pre-implantation Genetic Screening. That way, we can increase the chances of transferring a normal embryo without putting the patient under the stress (and additional cost) of repeated IVF cycles to boost the chances to find a quality embryo, which is the most-preferred approach of many fertility clinics in Europe. At the Cyprus IVF Clinic, our concern is you and your health, both physical and emotional. An unsuccessful IVF cycle involves a roller coaster of emotions and a lot of frustration. We totally understand that and do our best to prevent you from having to undergo a second or third cycle, whenever we can. Nevertheless, it is important to bear in mind that there are genetic abnormalities that we are unable to detect yet, which could cause IVF failure and not result in a live birth.
2. Unsupportive Uterus
The purpose of the uterus in case of pregnancy is to provide the developing embryo with a safe and nurturing environment to grow in. The functionality of the uterus, though, is affected by the presence of fibroids or polyps in the uterine muscle or the tissue lining the uterus called the endometrium. Then, the implantation of the embryo is impaired, and the pregnancy ends abruptly with a miscarriage, in most cases.
During an IVF cycle, we prescribe medications that cause the endometrium to thicken to desired thickness. Its receptivity, meaning how ready the endometrium is to have the embryo transferred into the uterus, plays a fundamental role in the outcome of the treatment. Its receptivity is determined by the window of implantation, which is the days between day 19 and day 21 of each menstrual cycle when an embryo is usually implanted. If, for some reason, that window is displaced a couple of days back of forward, we have what we call recurrent implantation failure.
How Can we Fix it: With specific tests that can help us diagnose receptivity issues. One of these tests involves the biopsy of tissue lining the womb (the genes in that tissue) during the window implantation days. This is a pain-free procedure which is much like the process you undergo for embryo transfer. Also, our esteemed fertility expert and renowned gynaecologist Dr. Firdevs also runs a full evaluation of both the uterus and uterine cavity prior treatment, to be able to suggest the best treatment protocol.
3. Immunologic Implantation Dysfunction
When a patient with a healthy uterus and chromosomally normal eggs cannot conceive through IVF, we often turn our focus on her immune system. Reproductive immunology is the field of medicine that allows us to identify how a patient’s immune system responds during pregnancy and how it interacts with her uterus and her other reproductive organs. When everything goes well, the implanted embryo is not considered a foreign body that the immune has to fight. But, a malfunction of the immune system will make it attack the embryo and either lead to a miscarriage or compromised fetal development.
This is usually the case with women that have activated uterine natural killer cells (NKa), who represent roughly 20% of the cases we treat at the Cyprus IVF Clinic. Studies have shown that 30% of women with endometriosis will have NKa cells, regardless of the severity of the endometriosis. Equally high risk of rejecting the embryo have women with an autoimmune disease, as well as women with a history of recurrent implantation failure or repeated pregnancy loss.
How Can we Fix it: Most fertility experts classify the cases of repeated pregnancy loss as unexplained infertility. However, Dr. Firdevs likes getting to the bottom of things and always works with her patients’ best interest in mind. For that reason, she exhausts all resources before reaching that conclusion herself. That being said, she asks for screenings that will allow her to investigate the patient’s antibodies, among others, and suggest the best protocol (both medication and treatment) for her case.
4. Sperm Abnormalities
This is the least probable cause that could lead to IVF failure and has to do with the motility of the male partner’s sperm and/or the sperm count, or sperm production disorders. Studies indicate that male factor problems represent about 30% of infertility cases. This could mean that the production of the sperm is not sufficient for fertilisation or that the sperm produced cannot penetrate the egg or that the sperm presents chromosomal abnormalities.
How Can we Fix it: Intracytoplasmic Sperm Injection (ICSI) is the most common method we use at the Cyprus IVF Clinic to treat male factor infertility, and allows men with low sperm count or low motility to successfully fertilise their female partner’s egg (or the donor egg if using donor eggs is the selected treatment).
Non-Biological Factors That Can Affect an IVF Outcome
These include factors that mainly have to do with improper lab installations and wrong technology used, as well as errors made by those using the labs or access technology or perform the surgical procedures required for IVF treatment.
1. Lab Environment
The environment of the lab where the egg and sperm are fertilised and hatching embryos grow until they reach blastocyst stage and are ready for transplant has to be strictly controlled. It is paramount to be able to simulate everything that happens to the egg, sperm, and embryo inside the patient’s reproductive tract. For that reason, factors, such as humidity, temperature, light, oxygen concentration, and carbon dioxide concentration must maintain optimal levels. Any fluctuations or changes in any of these factors could result in the death of the developing embryos.
How We Fix it: Most fertility clinics use traditional incubators. This means that their embryologists have to regularly check the embryos’ development by removing them from their incubators, exposing them to humidity and temperature changes, which increases the chance something goes wrong. At the Cyprus IVF Clinic, we are proud to have the Embryoscope, the latest in incubators, which allows our expert embryologists to monitor the embryos without removing them from the incubator at all.
That aside, our labs and operating rooms’ ceilings are equipped with multiple types of filters that ensure the gametes and embryos are always exposed to a safe environment. Also, the use of the most advanced technologies that allow us to minimise human intervention during each stage of the IVF treatment is another plus.
Finally, specialised staff performs daily quality assessments to ensure the optimal function of all our equipment.
2. Lack of Experience or Lack of Access to Advanced Technology
The embryologist is the one who will choose the best embryos for transfer. If he or she cannot identify the chromosomally normal embryos from those abnormal, either due to lack of experience or skills or inability to access advanced technology, there is an increased risk of selecting non-viable embryos. Despite the fact that we have limited ability to detect abnormal embryos at the moment, it is critical to be able to use the existing knowledge and, at least, master the existing technology (i.e. PGS) and known criteria that indicate whether an embryo is normal or not, such as cell stage, embryo grade, and cell division rate.
3. Wrongly-Performed Egg Retrieval and/or Embryo Transfer
Both egg retrieval and embryo transfer are surgical procedures that can determine the outcome of the IVF treatment. However, it is not only the procedures themselves that need to be performed correctly. The medical expert should also know particular details, such as how many eggs they need to retrieve from the patient to achieve optimal results. Also, the location inside the uterus where the embryo is implanted plays a crucial role in the success of the IVF treatment. Again, medical expertise is required.
There is a fine line that separates IVF success from IVF failure. Everyone at the Cyprus IVF Clinic is doing their best to make that line more distinguishable and find ways to provide every single woman with her undeniable right to start a family when she believes the time has come. Despite the challenges that might present themselves during IVF treatment, IVF is indeed very successful and has helped millions of couples facing female or male factor infertility have a child.
If you need to discuss your case with Dr. Firdevs and explore your options with her, please give us a call or contact us. Dr. Firdevs will carefully go through your medical records and medical history, among others, and suggest the best treatment for you. Don’t let your past unsuccessful attempts put an end to your dream. We are here to help…and know exactly how.