IVF Failure & How To Tackle It

Hello friends,

I am Dr. Rupali, work as a senior consultant in the department of IVF and reproductive biology. So, today I am going to talk about IVF failures and how to tackle it? IVF failure is such a very very important topic, a very frustrating topic for the treating physician as well as the patients. IVF failure ke kya causes ho sakte hai? Agar hum IVF failure ke baare mein soche toh yes, successful implantation yani ki ek successfully jo embryo uterus mein jaake chipakata hai, ek bahut hi complex procedure hota hai, aur bahut saare factors isme play karte hai. And as all of you know, in spite of all good factors, in spite of such perfect air-conditioned sperm conditions, embryo conditions, lab conditions we have seen that overall successful pregnancy rate with an IVF, nowhere crosses 48 to 50%. So, aaj mein apke samne isike baare mein kuch discussion karungi. Commonest factors which we can say, which are responsible for implantation failure are one is the uterine factor, agar mother ke uterus mein koi problem hai.

What is the common problem which can actually leads to implantation failure? The commonest problem is the thinning of the endometrium, which is the endometrium, which is there, jo andar ki lining hoti hai uterus ki, vo receptive nahi hai, vo embryo ko chipkane ke liye favorable nahi hai. Aur iss case mein kya kiya ja sakta hai? Aise scenario mein bahut kam options rah jaate hai, one is you try to increase the thinness of the endometrium yani ki andar ki jo lining hai uski thickness, uska motapa thoda sa badhane ki koshish karo, by giving drugs, injections etc. apart from that there is something called as endometrial receptivity assay, endometrial receptivity assay ek aisa test hai, jis se ye test karte hai ki kis samay mein, during the menstrual cycle, menstrual cycle ke kis phase mein, endometrium sabse jyada receptive hai. Embryo ko chipakne ke liye sabse jyada receptive hai. Usually, hum first IVF case mein, first IVF cycle mein hum ye nahi karte hai, hum ye tabhi karte hai jab humare ko doubt hota hai ya fir failure cases hote ha.jinme hum bilkul accuretely koshish karte hai ki embryo chipakne ka jo time hai vo accurate pata chal sake. Indeed agra bahut jyada IVF failures hai patients mein toh mu unko hysteroscopy ke liye bhi suggest karte hai. Hysteroscopy ek tarah ka examination hota hai jisme hum camera leke uterus ke andar wali lining aur uterine cavity ko ek baar dekhte hai ki sab thik thak hai ke nahi, kahi kisi taraf se lining kharab toh nahi ho rahi, jhilli jo andar ki jhilli hoti hai jaha pe chipkta hai bachcha vo kahi se moti toh nahi ho rahi hai, this is the other thing. Apart from that aur kya kar sakte hai, egg factor is very very very important when we talk in terms of IVF success. And here one of the most important factors jo egg ko influence karta hai vo hai patient ki age, mother ki age. Studies have shown that if the mother's age, if the female partner’s age is more than 35 years, toh usme fragmentation, genetic abnormalities, chromosomal defect bachche mein hone ke chance badh jaate hai. Apart from that egg vaise bhi bahut sensitive hota hai, free radical damage wagaira se. So that is why if the age is much higher say if the age is around 40 years then the chances of a successful IVF decrease. Aur iska kya tod hai? As such number one, jab bhi patient ho IVF ka if it is indicated do it at a younger age. Kam age pe, at a younger age less than 35 years of age, the chances of success are much better if we compare it to a patient who is 40 years of age. Dusra tarika ye hota hai, if the age is much higher then we might opt for donor IVF, where we can take donor eggs, that is another option. More so if there are multiple failures in the patient, bahut jyada baar cycles fail ho chuke hai uss patient mein. Coming to the next thing, talking about sperm factors.

Yes, so agar female mein problem hai yes, male mein bhi problem ho sakti hai. Like humara jo light microscope hota hai, humare paas jo magnifications hoti hai kai baar usme sperm defects ache se nahi pata chalte. So that is why there is something called as sperm function tests which have come up. Which are again not indicated in normal IVFs but haan agar kuch suspicion ho ki male factor mein kuch problem hai with some history, microscope mein dekhne ke baad agar lagta hai ki isme problem hai ya fir recurrent IVF failures hai, then we can do sperm function tests. Isse not only the morphology yani ki external look of the sperm but we can also assess the DNA of the sperm. The integrity of DNA can also be assessed by these tests and then we can choose good sperms, which is really really good for the formation of an embryo. Yes, eggs mein problem ho sakti hai sperms mein problem ho sakti hai, finally jo embryo bankar aata hai, usme bhi problem ho sakti hai. So jo banke aata hai, sometimes it is not up to the mark, upto the quality, jo mujhe microscope ke neeche dikh raha hai, uske hisab se jo corresponding day hai, uss level tak vo develop nahi hua hota hai, toh there could be a problem in the embryos. Apart from that IVF requires very very very strict lab conditions. Laboratory jaha pe culture ho raha hai embryos ka, they have to have the right temperature maintenance, humidity maintenance, no growth of microorganisms, in a very very sterile environment the carbon dioxide percentages are to be monitored and the growth of the embryo has to be monitored. So the culture conditions have to be maintained very very strictly very very stringently when we talk of an IVF lab, taki humare results ache aa sake. Apart from that patient, yani ki mother mein koi general condition ho jaise ki thrombophilia ho ya fir antibody syndromes ho these are two common practice which can lead to recurrent failure of IVFs and inn cases mein hum kya karte hai, we give them lower molecular weight happener, blood thinner diye jaate hai, taki unka blood thin rahe, taki unki endometrial receptivity better rahe. Endometrium tak blood flow normal rahe. But yes, let me make this very clear at the end of the day inspite of all these conditons still there can be IVF failures and every patient needs to be persistent, if they have good conditions, if they have some favorable conditions apko lage rahna padta hai, and in my experience somehow patients do conceive. I will definitely not commit to all patients but yes kaafi saare patients conceive kar lete hai jo persistent rahte hai, jo patience rakhte hai and lage rahte hai treatment ke liye.

Thank you.