In vitro fertilization or IVF is an assisted reproductive technology (ART) medical advancement that helps the infertile couple get pregnant, giving them a hope to become parents and the procedure involves multiple steps including stimulation, also called super ovulation, Egg retrieval, Insemination and Fertilization, Embryo culture and Embryo transfer. However, various infertility problems and if recurring, can act as a hurdle in addressing this aspiration as recurrent IVF failure means implantation absence post repeated embryo transfers and there are many factors that may lead to the same.
In an interview with HT Lifestyle, Dr Vinod Kumar, Consultant – Reproductive Medicine at Milann Fertility & Birthing Hospital in Bangalore’s JP Nagar, revealed, “Some of them are chromosomal abnormalities wherein there is an error in cell division resulting in meiosis or mitosis. Lifestyle is also an important factor. Research states that smoking and other unhealthy habits can adversely interfere with fertility procedures. Also, at times the ratio of ovarian response might be lesser or negligible for producing multiple eggs due to low ovarian reserve in a woman. Even the daily injections of follicle stimulating hormone (FSH) might not help much.”
According to Dr Ritu Sethi, Senior Consultant – Gynaecology at Cloud Nine Hospital and Apex Clinic in Gurgaon, some couples may have recurrent implantation failure despite following multiple cycles of IVF, which is defined as the inability to establish a clinical pregnancy after transferring at least four good-quality embryos in at least three fresh cycles in a woman under the age of 40. She listed the 3 factors that could be blamed –
1. Poor Quality Oocytes: A healthy egg gives birth to a healthy embryo. A chromosomally abnormal embryo can result from any chromosomally faulty egg. As the oocyte or eggs age, the spindle apparatus, or the structure responsible for the chromosomal separation and equal distribution, becomes more prone to disintegration. This results in an aberrant or anomalous chromosome distribution, creating a chromosomally abnormal embryo.
2. Poor Sperm Quality: Sperm abnormalities can result in an unfertilised egg. A sperm’s three main functions are to reach the egg through the fallopian tube, penetrate the egg’s outer membrane, and release half of the egg’s genetic material, or sperm DNA, to generate an embryo. For effective fertilisation, it is critical to select the best quality sperm under high magnification during IVF.
3. Wrong Embryo Selection: Choosing the right embryo is critical to successful implantation. The uterus is designed to reject defective embryos as a natural function. This indicates that the chromosomally defective embryo is unable to survive, resulting in implantation failure or miscarriage. Unfortunately, visually distinguishing chromosomally normal embryos from defective embryos is challenging. As a result, a thorough examination of the embryo’s health is critical for a healthy pregnancy.
If a couple has a failed IVF cycle for any reason, this does not mean that there is no hope of a pregnancy but it is important to understand why it happened and modify the treatment accordingly to achieve success in future cycles. There have been many cases where patients have conceived after 4-5 IVF cycles, when they were supplemented with recommended procedures like laser assisted hatching, microfluidics, pre-implantation genetic testing or injecting platelet rich plasma into the uterine cavity or even supplementing the diet with antioxidants etc as the case may require.