What is the cause of my Failed IVFs?



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 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

爸爸决定儿女一生- 风采杂志

feminine 20-6-2016

Daddy beware- How paternal age affects reproduction and offspring


Daddy beware

How paternal age affects reproduction and offspring


When it comes to discussions on fertilisation and reproduction, there is often an emphasis on the mother. This includes her age, which is also known as “maternal age.” This is quite understandable, because multiple studies have been conducted on women’s health and the effects it can have on the pregnancy and baby. And the bulk of the research shows that women over 35 do have a higher risk of infertility, pregnancy complications, spontaneous abortion, congenital anomalies and perinatal complications.

But what about paternal age? How come it’s rarely discussed? Could the age of the father have an effect on reproduction and the health of the baby both in vitro and after birth? The answer is – Yes, it’s possible.

Today, however, late fatherhood has become more commonplace. In fact, in Hollywood it has become a trend, with celebs like Steve Martin, George Lucas, Jeff Goldblum and Robert DeNiro fathering children in their 60s. And it’s not just celebs that are having children later in life.

In the last decade, we’ve seen a rising number of men becoming fathers for the first time at an advanced age. This is largely due to the increase in life expectancy, the use of contraceptives, delayed marriages and so on. Arguably, there are various social advantages to having children at a later age. For example, older fathers are often more advanced in their careers and are better equipped to provide financial security to the family. But what about potential risks? Do they outweigh the advantages?

Despite this rising trend of delayed fatherhood, research on the effects of paternal age on reproduction and offspring has been lacking. However, there is a growing body of literature on the topic, and they point to several risk factors that couples must be aware of and take into consideration.

Firstly, studies have shown the negative effects of paternal age to sperm quality and testicular function. In addition to this, older men have an increased risk of male infertility, which can adversely impact reproductive and fertility outcomes, including the success rates of treatments like IVF/ICSI.



Research also indicates that children conceived by men over the age 40 might face a higher risk of miscarriage; preterm birth; birth defects such as the bone growth disorder achondroplasia; disorders like autism, schizophrenia and bipolar disorders, as well as childhood leukemia.

But why do the risks for these health conditions increase with paternal age?

Researchers believe that these health conditions might be caused by age-related genetic mutations and chromosomal abnormalities, which in turn results in genetic mutations that are then inherited by the offspring. With these facts in mind, it’s essential for couples, especially those facing fertility issues, to consider the links between advanced paternal age and the potential risks to conception and the health of their offspring.

But, if you’re a man in your 40s or older who is considering fatherhood, or are concerned about your reproductive health, don’t hesitate to speak to your doctor. It’s best to address your worries and find out more about the potential risks involved.

Kate realised that having a child with a really tall father did have its advantages.

Kate realised that having a child with a really tall father did have its advantages.