For couples with previous IVF failures…
Unfortunately, IVF success rate is not 100%. Even under the best conditions, the possibility of achieving a healthy delivery is about 35-40%. So, how should the couples who have experienced IVF failure proceed? IVF treatment process is financially and spiritually challenging. It is a process where expectations are high; however when the result is negative there are deep disappointments. During this process, accurate evaluation, understanding couples’ needs, reviewing the process, determining proprietary services, offering the most cost effective treatment option should be among the significant responsibilities of IVF centers.
First of all, it is quite important to analyze the previous treatment process which resulted negatively. It is particularly essential to take control of this process which was performed in another IVF center. Why did they choose IVF? How many IVF attempts were made in total? Were there any concomitant deseases? Were the initial tests performed? When did the treatment begin? How many oocytes were retrieved? Did insemination occur? How is the embryo quality? Was the transfer easy? It is necessary to get answers to these questions…
Which special tests are required especially for couples with more than 2 IVF failures before beginning a new treatment?
It is useful to review initial tests and also perform basic tests such as fasting blood glucose and thyroid. It is fundamental to reveal ovarian reserve and to repeat semen analysis. After these;
Genetic blood analysis of spouses
Sperm DNA damage test
Office hysteroscopy to assess inside of the uterus
If not performed previously, we need hysterosalpingogram (HSG) to evaluate the tubes.
After these tests are performed, new techniques and which additional treatments will be used must be discussed with couples before making a new treatment plan.
Which additional treatments could be recommended to couples with recurrent IVF failures?
The treatment protocol used for the previous trial could be instructive for us. We might make some alterations in treatment protocols. Below are some of the treatments that could be performed:
IVF treatments without injections- natural IVF cycle
Drilling a vent on the embryo with laser
Scratching the uterine tissue
Performing frozen embryo transfer
Pre-implantation genetic screening (IVF with genetics)
Several treatments that are effective on the immune system
If a poor quality embryo was transfered during the first unsuccessful attempt, it will be beneficial to use procedures which improve embryo quality. In this case, developing a large number of oocytes, implementing a special ovulation trigger program, selecting sperms well, ensuring insemination in the best possible way and choosing the best embryo would be the path to follow.
For sperm selection: IMSI technique, PICSI technique and chip technique could be used.
The technique called co-culture which involves gathering blood taken from the mother-to-be and embryos together is among the recommended methods.
Drilling a vent on the embryo membrane is also one of the techniques that is widely used to help adherence.
If at least two GOOD QUALITY embryos were transfered during previous attempts, we might suggest hysterosalpingogram (HSG) and/or office hysteroscopy in order to assess whether there is a problem inside the uterus or not. If there is no problem, we might suggest pre-implantation genetic screening which involves sorting embryos after examining their genetics whereas eliminating unhealthy ones before transfer. Genetic screening stages are as follows:
Developing oocytes with daily injections
Inseminating retrieved oocytes with selected sperms in the laboratory
Obtaining embryos from inseminated oocytes
Obtaining cells from especially 5th day embryos through a special biopsy and performing genetic test (new generation sequencing-high resolution NGS technique)
Freezing all embryos
After acquiring genetic results, thawing healthy embryos and transfering them into the hormonally prepared uterus.
In PGT, which is a genetic IVF treatment, frozen and thawed embryos are used generally. There is a possibility of damage after freezing-thawing; however, the risk is quite low. The possibility of adherence of a genetically healthy embryo to the uterus is much higher than one that was not genetically screened.
Nowadays, with the help of technology, frozen embryo transfer is more common. With this technique, transfer could be postponed in case of negative circumstances encountered during treatment; moreover, the uterus could be rested and embryo transfer could be performed at a later date if there are low hormone levels which allow explicit betterment of pregnancy rates.
Advantages of frozen embryo transfer:
more natural intra uterine preparation and increase of the chance of adherence
Less medication usage
Low possibility of growth deficiency and preterm labor
Healthy pregnancies were reported in recurrent failure cases who have had frozen embryo transfers.