What is the cause of my Failed IVFs?

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Question: My husband and I had gone through 3 IVFs without success, does it mean that our chance of pregnancy is very slim? Is it due to my body condition?

 

Dr Helena’s Answer: To achieve a successful pregnancy through IVF, there are some basic pre-requisite factors:

 

(1) The age of the couple, especially the female partner
(2) The duration of Subfertility
(3) good quality and quantity of eggs and sperms to make good quality embryos
(4) a conducive uterus environment for implantation

Studies had also shown that there is a increasing cumulative pregnancy rate for women who went through a few cycles of IVF.

However, after going through three IVF without success, one may wonder whether there is light at the end of the tunnel.

Being a fertility doctor, I can understand how frustrating it would be. However, these IVF cycles which did not work out, may contain valuable information about your fertility. As we know, apart from being a treatment in its own right, IVF also serve as a diagnostic tool in its own right, by telling us how you respond to the medications, how your eggs and sperms qualities are, and how your embryos qualities are.

There a a few aspects we may consider to improve on for your next IVF treatment:

The IVF treatment protocol
The clinic
The sperm
The eggs
The uterus

Here are some consideration for you:

(1) The IVF Treatment protocol.

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While the IVF treatment protocol is pretty standard, every patient responds differently to the types and dosage of IVF medication. Each cycle teaches us how your body responds to the injections to help your follicles grow. It takes a good IVF doctor to be able to decide on the right dose and right type of medications, to get you to produce an optimal number of high quality eggs. Some young patients with normal ovarian reserve grow well in response to a standard protocol, patients with poor ovarian reserve and those with PCOS need a lot of extra attention and closer monitoring.

 

However, at the end of the day, some of this is trial and error. A good previous record can help us to learn from each cycle , until we can customize the perfect protocol for you
(2) The IVF clinic/centre.

 

It is important to note most IVF clinic/ centre are pretty standard, there are variations in terms of their operations and quality controls, and hence their success rates. In Malaysia, there is still no regulatory body that mandates each IVF clinic/ centre to report their success rates. However, it is important to look for credible centres with proper accreditation to ensure the quality of your IVF treatment.

 
(3) The sperm.

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Poor sperm quantity & quality may be associated with failed fertilization of an egg during an IVF but with the advent of ICSI, these problems are easily over-come. However, if the sperms are have high DNA fragmentation, the resulting embryos may still have poor quality. Simple lifestyle changes such as stop smoking & alcohol, weight loose, exercise and consumption of good quality food which are rich in anti-oxidants are some of the key elements in improving sperm quality and IVF outcome

(4) The eggs.

human-egg-cell-womb

 

Human egg is a thousand times bigger than the sperm, and that the energy for cell division during embryo cleavage comes from the mitochondria in the egg’s cytoplasm, therefore, egg quality is another important factor for IVF success. Poor egg quality leads to poor embryos and hence failed IVF. The problem is that it’s very hard to make this diagnosis, as there is no blood tests or medical technology to identify poor eggs prior to an IVF cycle. In fact, IVF is a diagnostic tool in it own right, as egg quality can be assess during an IVF. To improve egg quality involves making lifestyle changes, improving diets, and sometimes some alternative medications such as DHEA.
(5) The uterus.

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It is probably a very Oriental or ‘Chinese’ believe that failure to get pregnant/ implantation is always the fault of the uterus. It is not unusually to hear the terminology of ‘cold uterus’ being cited for the reason for not getting pregnant. Hence, the idea of surrogacy has become very popular recently because of the disproportionate amount of media attention it attracts, and especially so when cross borders IVF had become extremely popular with the ease of medical access overseas. This had lead to the idea that the best medical solution for them after many failed IVF cycles is surrogacy. After all, the fact that the embryos are not implanting means the uterus must be ” defective” , so doesn’t it make sense to use a fertile woman’s uterus as an incubator for 9 months ? However, the truth is that surrogacy is an expensive and complex treatment option, which is best reserved for women without a uterus. It is also important to stress that Surrogacy is ILLEGAL in Malaysia. Research shows that the reason for failed implantation is much more likely to be genetically abnormal embryos ( because of poor quality sperms or eggs), rather than a uterine problem. However, in about 20-30% of women, failure in implantation maybe due to some small correctable issues in the uterus such as polyps or fibroids. These issues can be dealt with easily without having to resort to surrogacy

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NTV7 活力加油站/亲子休闲 - 不孕不育,问题何在?- 林韵璇医生 Dr Helena Lim

Baby in the making

 

Cute Baby

Baby in the making- Study shows 3 out of 4 couples undergoing IVF will have a baby within five years

There are various causes for infertility, including endometriosis, polycystic ovary syndrome, damaged fallopian tubes and ovulatory problems in women, and low sperm count and motility or problems with erections or ejaculating in men. Unhealthy lifestyle habits such as smoking, illnesses like diabetes, as well as being overweight are also contributing factors.

In most cases, infertility can be treated, but for many couples who are struggling with infertility, In-Vitro Fertilisation (IVF) is their best option. Couples undergoing IVF are often faced with uncertainty and wonder – What are our chances?  When will we have a baby? Some undergo IVF multiple times without success, and as they are unsure of their chances, they end up giving up.

There has always been a debate on how best to measure the success of fertility treatments, however, now a Danish study is providing realistic information that’s reliable for the long-term prediction of treatment.

The long-term study was conducted by researchers at the Copenhagen University Hospital, who referred to rigorous registry records. Denmark is one of the few countries in the world where such a study could be carried out, due to their practice of keeping detailed records that link all fertility treatments to all live births.

The researchers analysed nearly 20,000 Danish couples from 2007 and 2010, following them from the moment they started their fertility treatments. The study’s findings were recently presented at the European Society of Human Reproduction and Embryology (July 2016).

The team found that more than half of the women (57%) had their baby as a result of treatment within two years, 65% had children within three years and 71% within five years. This means that almost 3 out of 4 couples undergoing IVF will eventually become parents within five years, whether as a result of the treatment or following natural conception.

Animated-Baby-Girl-Wallpaper-2

The study also found that while most causes of infertility can be overcome, the odds of conception are heavily influenced by a woman’s age. They found that in women under the age of 35, about one in three IVF cycles were successful and 80% had children within five years.

However, the total birth rates fell to 61% in those between 35 and 40 years old; and fell again to 26% in women aged 40 and over. The study also revealed that women with a Body Mass Index under 30 and didn’t smoke also had better outcomes.

These figures provide encouraging news for couples who are seeking or embarking on fertility treatments, as they reveal that their chances of having a baby are good. According to study presenter, Dr Sara Malchau, “We are now able to provide couples with a reliable, comprehensible, age-stratified long-term prognosis at start of treatment”.

Although individual prognosis and factors play a role in the success of IVF treatments, this study has shown that overall, IVF treatments are working, but they take time. Therefore, couples may need several treatment cycles for their best chance at conception.