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Why are my Fertility Treatments ending up in failed cycles?

Shukan Hospital and IVF Center   >>   Why are my Fertility Treatments ending up in failed cycles?

Fertility treatments that are not successful can take a toll on the couple, both emotionally and financially. However, the one benefit is that lessons can be learned from each failed cycle which will help in strengthening the reason for the next one to be a success!

There are various forms of ART (artificial reproductive treatment) technologies, the most common of which are the following:

Fertility drugs – if there is an ovulation problem, drugs like Clomiphene pills and Gonadotropin injections regulate hormones and help release egg/s. The pregnancy rate for this is about 25 – 40%.
A warning about these drugs/injections is that they can cause unpleasant side effects, like allergic reactions, headaches, fever, joint pains, etc. These medications should only be taken on the advice of medical practitioners or Infertility specialists.

Laparoscopy – a keyhole surgery to unblock the fallopian tubes or remove scarring caused by cysts, fibroids or endometriosis. The success depends on the circumstances of the individual. An after-effect of this is belly soreness for a few days.

IUI (Intrauterine insemination) – The female partner is stimulated by hormone therapy to produce more eggs during a particular cycle and the best quality sperm from the partner/donor is injected into the uterus. The pregnancy rate is about 8 – 20% in women aged under 40 years. A side effect is probable cramping for a day or so.

IVF (In vitro fertilization) – After hormonal stimulation of the female partner, the eggs are removed from the ovaries (oocyte retrieval), fertilized with the sperm in a petri dish in the lab and left to grow into embryos while being periodically monitored. Then the embryos are implanted in the womb. The success rate is 40% pregnancy rate and 33% live birth rate for women under 35 years, using their own fresh eggs. There may be unpleasant side effects and raised chances of multiple pregnancies.

ICSI (Intracytoplasmic sperm injection) – the embryo, resulting from a single sperm injected into a single egg is transplanted into the womb. The success rate is about 43%, slightly higher than the IVF.

DI (Donor insemination) – sperm from a donor is used by IUI, IVF or ICSI technique to fertilize the egg. The success rate is about 14% live birth rate (without fertility drugs) and 31% for IVF using fresh eggs and donor sperm for women under 35 years

Embryo donation – another woman donates an egg which is mixed with sperm and implanted in the womb. The rate of success is 32% live birth rate using fresh embryos from donor eggs and partner sperm and 30% live birth rate using fresh or frozen donated embryos in women of all ages.
These success rates can vary and are mentioned just to give an overall idea. Also, success rates in women above 35 years are usually lower. Studies have shown that the more the number of cycles of ART, the higher the success rates.

The reasons for ART failures are multiple and can refer to various situations, such as
  • Insufficient follicles are produced, so the IVF cycle is cancelled, prior to egg retrieval.
  • The quality of the embryo – sometimes, there are flaws which result in the embryo not implanting.
  • No quality eggs are retrieved – the age of the eggs plays an important part in this and, if the eggs are retrieved from a younger donor, the more chance of fertility, even if the woman is older!
  • The retrieved eggs do not fertilize or the fertilization is inadequate – sometimes, a woman’s ovaries do not respond strongly enough to fertility medications to produce multiple eggs, especially if the woman is over 37 or has high FSH (follicle stimulating hormone) levels. Hence, no embryo may be available for transfer to the uterus.
  • Transferred embryos may not implant for a variety of reasons (some of which are that the egg or the sperm have abnormal chromosomes) which will result in no pregnancy.
  • Lifestyle factors: 2 of the major issues are smoking and obesity. If smoking is cut and weight is lost, there is more chance of fertility treatments being successful.
  • Idiopathic factors: sometimes, all conditions are optimal, however, the ART cycle can end up in failure with no known cause.

Currently, before an ART cycle, or in some cases to help counteract the failures of previous fertility treatments, some diagnostic tests are recommended. The female and male partners undergo a battery of lab tests and other investigations to determine possible causes for infertility. From the male perspective, routine blood tests and basic semen analysis are normally prescribed. While the routine semen analysis test is very helpful as an initial screening tool, it has its limitations in that it reports only on the external characteristics of the sperm/semen sample and cannot give any indication of the DNA quality of the sperm which has been shown to play a vital role in the success of an ART treatment cycle and successful pregnancy. A Sperm DNA Fragmentation test or Sperm DFI test (DNA fragmentation index) is essential to evaluate the integrity of sperm chromatin or abnormal genetic material within the sperm which, in turn, can give more information about the DNA quality of the sperm and help the clinician choose the most appropriate mode of future treatments or in some cases provide answers to previous failed fertility treatments.
Hence, do not feel too despondent if your fertility treatments have not yet met with success. If you have not yet had a Sperm DFI test done, this could help answer unanswered questions. We at Andrology Center, offer the only standardized, best Sperm DFI test – the SCSA® Test. You can contact us at +91 9443793934 or email [email protected] for more information on the SCSA® Test.

If you’re undergoing or researching IVF, you may have learned that not all embryos are able to implant, and therefore sometimes the decision is made not to transfer an embryo to the patient after analysis is performed. The analysis used to make that determination is called blastocyst grading. What exactly is the embryology lab looking for when they perform blastocyst grading?
How a blastocyst is formed
First let’s define a blastocyst. In the IVF process, after eggs are retrieved by the physician, they go to the embryology lab. There, the eggs are fertilized by the sperm and the fertilized eggs (embryos) are further cultured. The embryos divide over the next few days and have a typical appearance as they progress. Approximately 5 days after retrieval, the embryos reach what is called the blastocyst stage.
A blastocyst consists of an inner cell mass (which forms the baby), the outer cell mass (or trophectoderm, which forms the placenta) and there is a fluid-filled cavity (the blastocoel). There also is an outer covering or “eggshell” (zona pellucida). The appearance or grade of the blastocyst can be used to predict the chance of pregnancy. A blastocyst with a higher grade has a better chance of implanting than one with a lower grade.
The blastocyst grading system
The embryologist will typically tell the patient that a blastocyst has received a grade consisting of a number and two letters, for example: 4AA.
The number explains the degree of embryo expansion of the blastocyst cavity and its progress in hatching out of the zona pellucida on a scale from 1-6; as the embryo expands, the degree of expansion increases. The first letter indicates on a scale from A to C (A being the highest) the quality of the inner cell mass, which potentially becomes the cells that form the body of the embryo after implantation.
The second letter is also on a scale from A to C (A being the highest), and this grade indicates the quality of the trophectoderm, the cells that give rise to the placenta and extraembryonic tissues after implantation. Implantation is the process of the human blastocyst attachment to the luminal epithelium of the uterus within six to eight days after fertilization.
What is the ‘perfect’ blastocyst grading score?
A morphologically “perfect” day 5 embryo transfer would be a 4AA; good expansion and excellent inner cell mass and trophectoderm. When the blastocyst scores 5AA on day five the blastocyst is starting to “hatch” with normal-appearing inner cell mass and trophectoderm. Therefore when a blastocyst scores a 6AA on day five, the blastocyst is completely “hatched” with a nice inner cell mass and trophectoderm.
While morphology is an important factor, do not panic if your blastocyst is not “perfect” quality! Many pregnancies do occur from AB or BB quality embryos; however, embryos with CC quality are considered non-viable and are not transferred.

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