In vitro fertilisation (IVF) has helped thousands of couples in Malaysia to conceive and complete their family.
However, not all couples who start their IVF journey succeed, especially in their first attempt.
These couples often become confused and worried about their path ahead.
While the pain is real, a failed IVF attempt is not the end of the road.
I have always told all my patients that IVF is their final test, the results of which reveals a lot about their own fertility.
It will show them information that a normal fertility test will not pick up.
Thus, a failed IVF cycle should be viewed as a step in understanding your body better and improving your chances of conceiving in your next attempt.
Why it can fail
Theoretically, IVF should result in a pregnancy every time a good quality embryo is created.
At least that is what is in the couple’s mind when starting an IVF treatment.
The reality is that many of the embryos created in an IVF cycle are not capable of resulting in a pregnancy.
That is the reason why women with low egg reserve tend to need more than one IVF cycle to create an embryo that can successfully implant to become a pregnancy.
So, failure in IVF is not uncommon and you are not alone in this journey.
There are a few common reasons why IVF can fail.
At the top of the list are embryo quality issues.
Not all embryos created are genetically normal or capable of implantation.
A genetically-normal embryo has a higher chance of implanting, although this is not guaranteed.
Implantation problems are also a significant factor preventing IVF success.
The uterine wall or endometrium may not be well prepared to accept an embryo.
Even though there are tests that predict endometrial readiness, they are not perfect yet and the science is still evolving.
Furthermore, these tests are very expensive.
Underlying medical conditions such as endometriosis, adenomyosis and uterine fibroids tend to lower IVF success rates.
The exact mechanism by which these conditions reduce pregnancy rates in IVF is not fully known.
This makes it difficult to find a reliable and consistent solution.
Male factor infertility also plays a major role in IVF success.
Damaged sperm cells can contribute to an abnormal embryo, even after successful fertilisation.
Emotional healing first
If IVF fails, the couple will experience disappointment, frustration, and sometimes, guilt.
These reactions are normal.
They may even face anxiety about starting the IVF cycle all over again.
First of all, as a couple, you should take your time and speak with each other openly about how each of you feels.
IVF is not only a medical journey, it is also an emotional journey for the couple.
Healing emotionally helps you see your path clearly, and you will be better prepared for your next step.
Review the data
An unsuccessful IVF cycle is not a waste of effort.
An IVF treatment reveals more information than a typical fertility test.
A woman will get more information about her egg quality.
The IVF laboratory will be able to assess the fertilisation capacity of the sperm.
The couple will get information about the quality of their embryo/s and how well they grow.
Typically, in a post-IVF review session, I will discuss with the couple about their IVF stimulation response, percentage of ovarian follicles with eggs, egg maturity, sperm quality on the egg collection day, and embryo/s grading and development.
During this review session, we might be able to identify infertility factors or clues that need improvement or adjustment to help them succeed in their next IVF cycle.
Once the post-IVF cycle review is complete, further tests or remedies can be recommended for the couple’s consideration.
For a couple who still have frozen embryos, the focus will be on either the remaining embryo/s or the womb.
For those who may need to restart a new IVF cycle, the focus should be to improve the egg and sperm quality.
Next steps
The woman can consider a hysteroscopy procedure before her next frozen embryo transfer.
Hysteroscopy is a procedure where a telescope is introduced into the uterine cavity.
This direct visual examination may provide more information about the uterine cavity, such as uterine polyps that were not detectable on an ultrasound scan.
It may also provide evidence of possible uterine infection known as endometritis, which can be treated before an embryo transfer.
Endometrial adhesions can also be corrected via hysteroscopy, which may improve embryo implantation.
For a couple with multiple unsuccessful embryo transfers, they can consider a blood test for Beta 2 Glycoprotein 1 antibody, which is associated with autoimmune-related miscarriage, thrombosis and infertility.
If the titre of the antibody is high, the woman may need oral and injectable medications as part of her embryo transfer plan.
Endometrial receptivity tests have also been used to assess the window of implantation for the woman.
However, current studies offer mixed evidence about its effectiveness in improving live birth rates in IVF.
Pre-implantation genetic testing (PGT-A) can also be considered for couples who still have remaining frozen embryos.
The aim is to choose a “genetically-normal” embryo, which may have a much higher chance of implanting.
However, couples who are considering PGT-A should also discuss with their fertility specialist about the disadvantages of PGT-A, especially false positive and false negative results.
Intrauterine platelet-rich plasma (PRP) can also be considered for the subsequent embryo transfer.
PRP is prepared using the woman’s own blood, which is centrifuged in a specially-designed tube to separate the plasma from the blood cells.
It is typically injected into the uterine cavity a few days before embryo transfer.
By releasing growth factors, it enhances endometrial thickness and receptivity.
“Embryo glue” is another remedy that can be used for an embryo transfer.
It is a specialised hyaluronan-rich transfer media used in frozen embryo transfers.
It acts as a biological adhesive that helps the embryo stick to the uterus.
Couples should also focus on improving their lifestyle choices.
This is often overlooked by many.
Maintain a healthy weight; avoid smoking, vaping and excessive alcohol; manage stress and sleep quality; and eat a balanced diet as much as possible.
These changes can improve egg and sperm quality, especially if you are considering another IVF cycle.
Adjusting the treatment plan
When can you start the next treatment?
Medically speaking, the woman can start her next treatment cycle the following month.
However, the actual timing will depend on the woman’s psychological recovery and the remedies that have been outlined by her doctor.
Both husband and wife need to be ready as a couple to take the next step.
The subsequent embryo transfer and IVF cycle might be different from the first attempt.
There could be a different regime to prepare the uterus lining for embryo transfer, on top of additional medications to support the uterus.
As for the IVF cycle, the ovarian stimulation medications or regime could be changed.
Furthermore, support medications to improve egg and sperm quality could also be started for few weeks before beginning the new IVF cycle.
IVF is not a one-size-fits-all treatment and it evolves with each cycle.
If your IVF has failed, it is understandable to be discouraged and disappointed.
IVF is a powerful tool, not a magic solution.
Failure does not define your fertility story.
Look for lessons that can be learned from the failed cycle to guide your next move.
Your journey may take time, but time does not erase a possibility of creating a family.
All the best on your fertility journey.
Dr Agilan Arjunan is an obstetrician and gynaecologist, and fertility specialist. For more information, email starhealth@thestar.com.my. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
