Failed IVF, what you need to know

Infertility is considered by the World Health Organization (WHO) a pathology, defined as the absence of conception after 12-24 months of regular unprotected sexual intercourse. It is a very impactful condition worldwide, affecting about 10-12% of couples.

For this reason, the use of in vitro fertilization techniques, or IVF, is increasingly becoming widespread, either through one’s own eggs, carefully harvested, or through donated eggs.

However, it is important to consider that these techniques are not infallible and can lead, under certain conditions, to a negative outcome, and couples need to be thoroughly informed about this.

 

Is it possible to recognize symptoms of a failed IVF?

To date, the only really reliable test to recognize the success or failure of an assisted fertilization treatment is the pregnancy test with beta hCG. It can be performed either on a urine sample or better with a blood test to search for and quantify the levels of beta hCG hormone.

The woman may also complain about the presence of physical symptoms that commonly occur at the beginning of a classic pregnancy such as abdominal discomfort, nausea, fatigue or drowsiness, but these are not always indicative of treatment success, but can be secondary to the effects of the administered drugs and may occur even in the absence of pregnancy.

On the other hand, the absence of clear symptomatology should not be a concern as a pregnancy in the early stages can proceed smoothly in an asymptomatic manner.

Another possible symptom that could be perceived as alarming is vaginal bleeding. The presence of bleeding does not necessarily imply a therapeutic failure, indeed, it could be a sign of successful uterine implantation (called implantation bleeding).

It is good medical practice, as also defined by the specialists of the Fertilab clinic, to never interrupt the prescribed pharmacological treatment until we have the results of the beta hCG analysis, also because of the frequency with which this particular symptom occurs in the case of positive pregnancy.

Menstruation can also reappear at different times, depending on the treatment used, for example:

In patients who have had embryo transfers on a natural cycle, the cycle usually returns on the usual days;

When we administer hormonal drugs instead, the cycle tends to return two or three days after the drug is stopped. If it does not occur after this time window, it is advisable to seek consultation with the gynecologist.

It is likely that the first menstruation is also different in duration and intensity than usual; therefore, the patient should be thoroughly informed about this, to avoid unfounded concerns.

 

 

What could be the causes of IVF failure?

Identifying a definite cause of infertility is extremely complicated, given the strong heterogeneity of the pathology; therefore, it will be equally difficult to establish why the implemented IVF treatment failed. For this reason, the Fertilab clinic ensures a personalized and professional evaluation tailored to the selected case, so as to establish a cause and prognosis as certain as possible.

First of all, it is necessary to divide the factors into two major groups:

Those to be studied and interpreted before treatment;

Those that instead would have a prognostic value when deciding to make a second attempt post-failure.

 

Pre-treatment factors

Included in this group are:

• Maternal age: as already explained, advancing years affect the number and quality of eggs produced and therefore the possibility of becoming pregnant;
• The presence of an altered male counterpart;
• Body Mass Index or BMI: in women, this index has values between 19 and 30 and indicates the ratio between weight and height squared. Their deviations, both in excess and in defect, lead to a reduction in the woman’s fertility rate. In this case, there tend to be ovulatory problems and a higher risk of miscarriages. Moreover, obesity also seems to affect male fertility, as excessive adipose tissue reduces the amount of testosterone in favor of estrogens, altering the reproductive system;
• Endometriosis;
• Antral follicle count: the follicle count is one of the most reliable indices we have to calculate pregnancy capacity;
• Toxic factors: cigarette smoking habits and excessive alcohol consumption, as well as excessively unregulated diets, expose to a higher probability of negative outcome;
• Anatomical anomalies.

 

Post-failure factors

Included in this category are:

• Ovarian factor: depending on what the ovarian response to treatment has been, we can modify or personalize the method with a second attempt, adjusting hormonal levels, especially progesterone, a useful index of endometrial receptivity;
• Endometrial factor: the presence of uterine abnormalities, poorly proliferative endometrium, endometritis, alterations of the immune system and predisposition to thrombotic diseases, are causes of repeated IVF failures;
• Poor quality of seminal fluid: although the modern techniques at our disposal allow us to use ICSI even with a small number of sperm, these must however be of suitable quality, so it is a parameter to consider in view of a subsequent attempt;
• Embryonic quality: the quality achieved by the embryos during the growth phase is important, as it represents a good predictive index on pregnancy;
• Quality control of the laboratory and adequate medical personnel.

 

What is the timeline for a second attempt?

When the first attempt has failed and a second ovarian stimulation will be opted for, it is advised to wait at least 2-3 months. Indeed, during this time frame, the medical staff will work primarily to identify the cause of the failure so as to personalize and refine the method, and in the meantime give the ovaries an adequate break.

On the contrary, it is not necessary to wait these months, if the plan includes a cryotransfer, as it is not necessary to stimulate the ovaries and with menstruation the endometrium will already be regenerated. Therefore, only endometrial preparation will be done and then proceed to thawing and subsequent embryo transfer.

The clinic also provides psychological counseling for the woman, as facing a failed attempt can induce a state of understandable discomfort and shock, especially if it is also preceded by failed natural attempts.

 

Natural Pregnancy after IVF

According to a study conducted by Monash University in Melbourne, on 236 women who have given birth with in vitro fertilization or other assisted reproduction treatments, between 33 to 46% were able to conceive a second child naturally within 2 years from the first birth.

Moreover, the possibility of becoming pregnant even after a failed IVF treatment is possible and this is demonstrated by a study from Imperial College and King’s College in London: the scientists followed a sample of 403 couples for a period of 6 years post failed treatment noticing that 3 out of 10 managed to become parents.

A possible explanation for this seemingly inexplicable event is that ART techniques are often used even in conditions of not particularly severe infertility, so even if the ART cycles fail for the most varied reasons, a spontaneous pregnancy is still achieved afterward.