Going through IVF is no guarantee of having a child – the odds of success are about one in three and it’s no exaggeration to say it is a challenging journey – physically and emotionally
Success rates are getting better, but, sadly, most women need to go through a number of IVF cycles before there is the much wanted outcome, if at all.
But when you long for a baby, when it becomes the most all consuming heart wrenching overpowering need, you just don’t care about the statistics or the small print, do you?
We know only too well the feeling of a failed round of IVF. The shock, disbelief, raw pain, grief, confusion, and overwhelming sadness. Despite the statistics, we just assume it’s going to work; which makes that phone call from the embryologist, telling us that we didn’t produce enough eggs so the cycle is cancelled, or no eggs were fertilised, or the embryos just didn’t make the grade, or they didn’t implant, even more unbearable.
Or perhaps you are trying to digest the heartbreaking news that you miscarried, to realise that your IVF has failed brings such an overwhelming sense of sadness and helplessness, it is hard to comprehend.
But regardless of what stage your treatment failed, the pain still penetrates deep. The only way to cope with this pain is to get the answer to the only question that matters – WHY?
We asked the Lister Fertility Clinic‘s Dr Raef Faris his expert opinion on why it doesn’t always work.
Why does IVF fail?
IVF is the most effective form of assisted reproductive technology, but we know that it doesn’t always work. Below are the reasons your IVF may have not have worked:
Chromosomal abnormalities in the embryo
The development of an embryo is a complex process during which either a genetic abnormality in the embryo, or an abnormally developing embryo will stop growing. Despite the embryo appearing to being top grade under the microscope, miscarriage and implantation failure can still occur due to chromosome abnormalities that usually happen as a result of an error in cell division. When an embryo is created, it should consist of 23 chromosomes from the egg and 23 chromosomes from the sperm. A missing or extra chromosome may cause the embryo to not implant or a pregnancy miscarry.
Poor egg quality due to age
Birth rates decrease with age where the woman’s own eggs are used, as does the risk for a baby to be born with a chromosome abnormality. This is because the eggs are aging, and may have the incorrect number of chromosomes at the time of fertilization.
The percentages below from the Human Fertilisation and Embryology Authority(HFEA) show the average chance of a birth from IVF treatment depending on a woman’s age. These figures are for women using their own eggs and their partner’s sperm per embryo transfer:
- under 35: 29 per cent
- 35-37: 24 per cent
- 38-39: 17 per cent
- 40-42: 11 per cent
- 43-44: 4 per cent
- over 44: 3 per cent
Remember, you have options. If you can’t use your own eggs, using a donor egg is something really worth considering. There are so many amazing women who have had children using a donor egg. There are also incredible support groups that will help guide you.
Negative receptivity of the womb
This could be due to an abnormality in the structure of the womb like a uterine septum or the presence of fibroids. Failure to implant or recurrent miscarriage could also be caused by an abnormal thyroid function, clotting problems, or ‘sticky blood’.
If the lining of your uterus is too thin, then the embryo will struggle to implant. The lining should ideally be no less than 7mm. Progesterone given towards the end of the IVF cycle will help to maintain the thickness of the uterine lining.
Failure to fertilise retrieved eggs
Having been through the hard work of stimulation and retrieval, let alone the mental exhaustion, to then be told that no eggs were fertilised, is a huge disappointment.
This occurs when a man has decreased motility and the sperm did not penetrate the egg. A solution to this problem, is to have ICSI (intra-cytoplasmic sperm injection), where the sperm is placed directly into the egg.
Cancellation of a cycle
Being told you have to cancel your IVF cycle is frustrating to say the least. It is something most people just don’t think about before they begin, but cancellations can happen when the patient develops medical complications that make it impossible to transfer embryos to her uterus.
Inadequate quality eggs are retrieved
Women whose ovaries don’t produce enough eggs, or in fact any eggs (or follicles) during treatment will sadly face the prospect of a cancelled cycle. The ideal follicle should be between 18 to 20 millimetres. You need three to four mature follicles for egg retrieval.
OHSS (ovarian hyperstimulation syndrome) is a rare side effect in which your ovaries suffer with being overstimulated and begin to swell. It generally occurs from the fertility drugs used in IVF and can develop several days after egg retrieval, or in very early pregnancy. In most cases, OHSS is mild and only causes minor to moderate discomfort, but if it becomes more severe, embryo transfer may need to be cancelled or postponed, and all embryos are frozen for future use.
What is the first thing you do when you realise your IVF cycle has failed?
Arrange the first available appointment with your clinic. This will usually occur within a couple of weeks. The Doctor will review the previous cycle and use it as a diagnostic tool, assessing its different stages and advising on any changes or any investigation before embarking on another cycle.
How quickly can you start another round?
A woman can theoretically start the next round of IVF with her following period. But it is important to tailor this plan to the choice of the patient considering the emotional physical, financial, and social demands. It would be essential to offer counselling as support during this period. It is important to remember that a failed IVF cycle or miscarriage is a bereavement like any other and you should give yourself time, and space to digest this.
What tests are available to assess why a round has failed?
Hysterosalpingography will assess the uterus for any anatomical problems, allowing the doctor to evaluate the shape and structure of the uterus, the openness of the fallopian tubes, and see if there is any uterine scarring.
PGS, or more recently renamed PGT-A, is when a biopsy of cells from the embryo is removed to check the number of chromosomes that it has.
What do I need to ask my doctor?
We have always found that as soon as you sit down with your doctor your mind can go blank. The stress and heartbreak of a failure can lead to a complete flatline and you leave with so many questions unanswered. So we have listed a few questions below that you can write down and take with you to your next appointment. You can also download our checklist and run some of the tests past your doctor to see if any are relevant for you.
- Have you had all the necessary blood tests and scans to ensure that nothing’s been overlooked?
- Are you 100 percent satisfied that there are no underlying medical factors that are stopping your pregnancy, such as blocked fallopian tubes, thyroid problems, polyps, fibroids, low egg reserve or any other possible issues that could be at the root of the problem?
- Do you have any immune system issues? Has this been tested? When?
- Is your consultant satisfied that the drugs that were given to you before and during IVF worked as they should? Are there any other drugs that might work better?
Who can I download my sadness to?
The devastating emotional impact of a failed IVF cycle is overwhelming, unbearable and cannot be overstated. In fact, women who can’t conceive naturally have been found to have elevated anxiety and depression levels similar to women with heart disease and cancer. This is understandable; many couples find themselves in grief or in mourning after a failed IVF cycle. It is a sense of loss and shock that you are simply unprepared for.
This pressure can have not only a significant negative effect on a couple’s relationship but on relationships with friends and family which is why finding the right person to talk to is so important. Being showered with care in the form of cups of tea and cuddles from the people you love just isn’t enough. You want someone who can help you deal with this raw pain. You can find this relief in the form of a counsellor or someone who has experienced failed IVF.
But remember that IVF babble is here to support you on your journey, make sure you join our online community by liking our social media pages, @IVFbabble on Facebook, Instagram and Twitter, where you will find thousands of others going through the same feelings and anxieties as you