Repeated IVF Failure in India

• Poor Oocyte Quality: With increasing age, the quality of the oocyte is likely to reduce. The oocyte plays an important role in the cell division and chromosomal duplication during the embryo formation. Poor oocyte quality implies break in the spindle apparatus in the oocyte resulting in damaged DNA and a chromosomally abnormal embryo.
• Poor Sperm Quality: In case of poor sperm quality, the sperm may not be able to break the outer shell of the egg or at times lead to poor fertilization in IVF failures. At times, a high-quality sperm is unable to break the outer shell of the egg.
• Wrong Embryo Selection: If the IVF specialist selects an abnormal embryo, the uterus is likely to reject it. It is extremely essential to choose and test a chromosomally normal embryo for a successful IVF cycle.
• Issues in the Uterus: If there are issues in the uterus, especially the endometrial environment, then there are high chances of failure of the IVF cycle. Hence, it is necessary to conduct a thorough check of the uterus in terms of hormones, structure and immunology. Faults in the structure of the uterus such as fibroids, polyps, difficult cervix, intrauterine adhesions, and abnormally shaped uterus also increase the chances of failure of the IVF cycle. Another reason that leads to failure in the IVF cycle is a thin endometrium in the uterus due to high progesterone before the egg retrieval in the IVF cycle.
• The lifestyle of the partners: The lifestyle of both partners in the IVF cycle matters. If one or both of them have resorted to the consumption of drugs, tobacco, and alcohol and so on. Their consumption is known to lead to complications during the IVF cycle and pregnancy as a whole. Similarly, if the partners suffer from hypertension, diabetes, blood clotting and other autoimmune disorders, there are high chances of failure in the IVF cycle.
• Issues with Embryo Transfer: Though Embryo Transfer is a sensitive but non-surgical procedure, yet it should be performed at the right place and at the right time. It is advisable to perform a trial transfer to ensure that the embryo will be placed at the right location in the uterus to reduce the risk of a failure of the IVF cycle.

Well, accurate diagnosis of repeated IVF failure in India paves the way for determining the right approach in yet another attempt of the IVF cycle. The gynecologist will suggest any or few of the following tests that ascertain the cause of the IVF failure.

• Uterine Evaluation/Hysterosalpingogram (HSG): The in-depth Uterine Evaluation will evaluate the condition of the uterus and fallopian tubes in great details. This helps in knowing the exact tubal status for a successful IVF cycle and reduce failure risk by nearly 50%.
• Sperm DNA Fragmentation Test: This test looks into the quality of the DNA in the sperm. If the sperm DNA fragmentation assay in very high, then it could lead to failure in IVF cycle, miscarriages, low fertilization chances and so on. Also, there are instances of normal sperm with abnormal DNA fragmentation. It is a relatively new test, and its reliability has yet to be determined.
• Endometrial Receptivity Assay (ERA): This test refers to the biopsy of the endometrium wherein the gene expression investigations indicate the receptivity of the uterus towards the implantation. It guides the IVF specialist to determine the most suitable day for implanting the embryo.
• Preimplantation Genetic Testing: The PGT test is directed towards checking the chromosomes in the embryo. Embryos with a normal count of chromosomes are selected for embryo transfer for success in the IVF cycle and reducing the risk of a miscarriage along with the birth of a normal child or children as the case may be.
• Immunology test: The IVF specialist may suggest certain tests to check the immunologic abnormalities, which could include immune cells or proteins. The tests results could give the specialist a clear picture regarding the cause of the failure of the previous IVF cycles and how to proceed with the next one. Only if the results of other tests do not reveal the cause of the failure, then it becomes essential to undergo these tests.

If the IVF specialist can accurately detect the cause of the failure of the repeated IVF cycles, then he or she can proceed in a more planned manner during the upcoming IVF cycle.

The IVF specialist could pay more attention to the embryo transfer procedure and its schedule or emphasis on choosing healthy oocyte and sperm or check out the uterine environment for the best location of implantation and so on.

The key to a successful IVF cycle is to accurately diagnose and detect the reason for failure in the earlier cycles and choose to avoid their recurrence in the present cycle.