Given the time, emotion and money that go into an individual IVF cycle, I would love to be able to guarantee that it will result in a successful pregnancy for all of my patients at Sher Fertility Institute New York, but unfortunately this is not the case. When a cycle is not successful, there are several potential causes. I find it easiest to think about the possible causes in broad categories:
- Did a sufficient number of eggs grow and did they fertilize normally?
- Was there a problem with the quality of the embryos created, and if so, did the quality problems stem from egg, sperm, or a combination?
- Was the endometrial lining thick enough, and does it function normally to allow for proper implantation?
- Were there any hormonal changes that affected the window of implantation?
- Is there an underlying immunologic condition leading to IVF failure?
- Was there anything within the anatomy of the pelvis that could have affected pregnancy?
Once all of the above have been considered, I try to figure out what additional tests (if any) can be done, or how a protocol can be adjusted for a future IVF cycle. Sometimes we have to get creative and break away from a “typical” protocol. Each patient/couple has their own person situation, and what works for one may not work for another. There is always a way to achieve a successful pregnancy, as long as patients are open to various treatment options. If the first IVF cycle does not lead to a live birth, we need to learn from that cycle to hopefully increase the odds of each successive cycle.
A young patient of mine, after being unsuccessful with IUI, opted to try IVF. Unfortunately, she seemed to have problems overcoming every hurdle in her IVF cycles up until the day of embryo transfer. Her ovaries did not respond well to the stimulation medications, we rarely retrieved more than 3 eggs in a single cycle, and the percentage of eggs that fertilized normally (even with ICSI) was low. I reassured her that at her age we only needed one good quality embryo. She ended up attempting 6 cycles of IVF in total using different protocols to adjust her hormonal environment. Two of these cycles never got to a retrieval because of her poor response, and of the four cycles where I did retrieve eggs, there were only two where embryos were successfully created. After her first embryo transfer she was pregnant, but unfortunately it was an ectopic pregnancy. In her last cycle, we were able to transfer an embryo which led to a healthy and successful pregnancy.
So in the end, it was about adjusting and accounting for each of the variables according to her individual needs in order to optimize her chances of having a baby.