A very common question being asked after an IVF failure, in spite of transferring good quality embryos. In fact a very frustrating moment for the infertility specialist also.
The couple and the treating specialist usually develop high expectations after seeing beautiful embryos on the monitor. But reality is an implantation rate of 25-40%.
Another tendency is to blame the uterus as the cause of failure as embryos seemed very good at the time of transfer. But this is not true.
In 2/3 of the implantation failures the uterine receptivity is the major causes and in approximately 1/3 the embryo quality, as all good looking embryos are not genetically normal.
Implantation failure doesn’t always mean an uterus with some inherent defect or permanent inability to implant and grow a baby. As many of these patients may conceive with donor oocytes. The major cause of implantation failure in self cycle is hormonal effect on the endometrim due to stimulation process used on the ovaries. They alter the intrauterine environment with which the embryos interact.
Now few solutions to these problems which can work to some extent. Certain modifications in the stimultation protocols and freezing all resulting embryos and transfer after some time have promising results.
Whenever a sudden shift is made from fresh embryo transfer to frozen embryo transfer the couple usually have many queries in mind. So, let’s evaluate both and see pros and cons.
Fresh embryos transfer is undergoing ovarian hyper stimulation making of embryos and transferring resultant embryos to uterine cavity in same cycle. In frozen embryo transfer first two steps of controlled ovarian hyper stimulation and process of IVF/ICSI are same but the resultant embryos are frozen using vitrification techniques and not transferred in same cycle. They are thawed and then kept uterine cavity after preparing the uterine cavity.
In patients who are normal or hyper responders the frozen embryo transfers are known to have better results than the fresh embryo transfer . The reason can be that due to ovarian hyper stimulation and high levels of estrogen may have negative impacts on the endometrial receptivity. In some cycles another hormone called progesterone may also be raised, which again decreases embryo implantation rate. Whereas in frozen embryo transfer the body and uterus have already recovered from the impact of hormonal disturbance and hence more receptive.
Because of their reason in patient with PCOS the frozen embryo transfer is associated with higher live birth rate. It also reduces complications like ovarian hypertimulation in these patients.
Another reason where we make a sudden shift from fresh to frozen embryo transfer are when the ovarian stimulation part is good but the endometrial thickness fails to reach an optimal level.
So because of the above reasons we are moving towards more frozen transfer than fresh transfers in self cycle.
Adenomyosis is a condition in which the cells of endometrium (the uterine lining) are present inside the muscular wall of uterus. There is also associated hypertrophy uterine muscles.
Adenomyosis can affect fertility in two ways. Firstly it effects the uterine contractions which helps sperms to reach the tubes. Secondly it also increases the number of toxic cells in the uterine lining which may effect the implantation of embryos.
Adenomyosis may also be associated with endometriosis, a condition in which the uterine lining cells are present in the ovaries or other sites in pelvic. This may further effect the oocyte quality and number, further contributing to difficulty in conception.
The most common question asked in IVF counsellings is “Doctor, as we have heard, we need to do complete bed rest after embryo transfer or I can move around. Do you think 15 days leave is sufficient.”
So it’s time to give away this myth forever now. The implantation of embryos placed inside your uterus after embryo transfer depends upon three most important factors –
- Quality of eggs
- Quality of sperms
- Receptivity of endometrium.
Moreover uterus is a collapsed cavity with opposins walls and a closed cervix. If the embryos are placed inside the uterus at their proper position then few minutes after embryo transfer they remain at their same stable position and in no ways they will fall down even if you stand after the embryo transfer.
Going by literature, various studies have been conducted in which pregnancy rates were compared between the groups who were made to get up 20 minutes after the embryo transfer and those made to rest for varying periods from 3 minutes to even 24 hours in some centers. But no difference was found in the pregnancy rate and the live birth rate. In certain systemic reviews and meta analysis it has been shown that complete bed rest might negatively affect the outcome of IVF/ICSI cycle and the cause may be stress and anxiety mechanism.
So a lot of evidence is against the bed rest factor. Even at Reviva we have seen pregnancy rate comparable between the bed rest and no bed rest groups. I can recall many positive results even in those patients who jump out of bed even half an hour after transfer and those joining their offices the very next day. But inspite of clinical evidence we daily come across patients who had undergone failed cycles at other centers or one of their relatives had undergone treatment elsewhere and were advised complete bed rest after transfer and to the extent that they were kept hospitalized for 24 hours. All this increases the anxiety factor in the patient. Very obvious that lying on bed the whole day is not easy and the thought process is totally focused on one thing and more of stress and negative feelings. How do you think it’s going to help the success rate. And if unluckily the results negative than the female takes the whole burden on her. She thinks it didn’t work because she didn’t have sufficient rest.
So our advice to all our patients, don’t go on house arrest of 2 weeks. Take it easy and carry out with your normal activities. Rest is not going to influence your outcome. So relax, be normal and wait for nature to do its best.
- Published in IVF
In about 50% of our patients, being taken for IVF, the oocyte quality or quantity is the major concern. It’s very easy for us to show you the path of egg donation as it is a routine for us. But we know it is not that simple for you. Though it carries a very high success rate, but psychological implications on the recipient are very high.
The major indications for IVF with donor oocytes in REVIVA are –
- Premature ovarian failure
- Decreased ovarian reserve
- Recurrent self cycle failures with no proven endometrial or male factor.
- Genetic causes.
It takes time for the couple to accept the option of Donor eggs, but usually the desire of having a family overcomes this hesitation.
The most important concern of the couple is the quality of genes transmitted to the child. Though the anonymous egg donor is being matched to the recipient as far as possible, the concern always remains in majority of recipient; they are satisfied with their gestational contribution which creates a strong bond.
Another way of dealing with it is to keep the information of type of cycle between the couple only, it will serve you from interrogation eyes and any future problems will be avoided.
On positive note egg donation is associated with many benefit. The most important since eggs are derived from a young woman, they are more likely to produce chromosomally normal embryos and so risk of abortions and birth defects is less.
So, though egg donation is not the first choice of anyone, but it is treatment with very high success rate where it is indicated.
This is a clinical entity where the uterine lining cells are present outside the uterus, usually, ovaries. The incidence is in reproductive age group.
This condition effects your chances of conceiving by decreasing number and quality of eggs, causing pelvic adhesions and hence tubal blockage toxic microenvironment and also effects endometrium receptivity. (2-10 % in women in general population and 20-30% in infertile group)
Women with endometriosis are 5% less likely to continue naturally even in cases of mild endometriosis. In severe endometriosis the fertility decrease is much higher.
Now since endometriosis is an on-going process, so when diagnosed we tell the patient to plan early. Even after surgical removal of endometriotic cyst, the non visible endometriotic spots continue to release toxins which can effect your fertility. And if patient doesn’t take any treatment after surgery and doesn’t conceive within six months, the pre-surgical state may come again. So postsurgery aggressive treatment is required in cases of grade 3-4 and those with grade 1 and 2 are advised to plan early either naturally or IUI.
Well-being may be the most vital part during pregnancy. There would be both mental furthermore physical changes,even then you need to be in your healthiest so as to provide the best nature’s domain to your child. In order to cope up with the physical changes, one ought to think of meditation.
- DISPOSE OF CRAVINGS – Craving is one of the normal part during pregnancy. Here and there it may be challenging to oppose cravings to bad things. Contemplation might make used to viably address these cravings.
- LESSEN STRESS – Now and then pregnancy may not be simple. Tension, anxiety, stress, all are normal things during pregnancy. Excessive anxiety and stress can put negative sway on your well-being and also for your baby’s well-being. Meditation can diminish anxiety and might be carried out anyplace.
- ENHANCES SLEEP – Sufficient rest is necessary for you and your infant. Meditation enhances sleep. With sufficient rest and sleep, those temperament and level claiming vitality will enhance.
Ovarian reserve is the number of eggs in the ovaries at a particular time. It is like a jar where few follicles are used every month but you cannot add anything into it.
Intrauterine this pool is 6-7 million , but at time of birth only 1-2 million are left due to autodegeneration. This number further reduces to 2.5-5 lakh at puberty. As the process of selection and degeneration goes on this pool is depleted as we age.
Now what can be cause of low ovarian reserve i.e. the reserve is less than that speculated for age.
These can be –
- Genetic Predisposition.
- Chromosomal anomalies
- Destruction of ovarian reserve by surgery, Endometriosis, other benign or malignant ovarian tumors. Pelvis adhesions,etc.
The best way to diagnosis low ovarian reserve is ultrasonography ( Antral follicle count ) and Anti- Mullerian hormone (AMH).
There are many IVF protocols and treatment modalities which we are using for patients with limited ovarian reserve but these may work in some and not at all in other and for them donor eggs is the next option.
Eating spicy food causes an ovulation, low sperm count, miscarriage and premature delivery.
FACT-> Eating spicy food only occasionally disturbs the gastrointestinal system and sometimes causes heartburn.
Seven to eight days of abstinence are required before a semen analysis, or before giving a sample for IVF/ICSI/Sperm freezing.
FACT-> Increased days of abstinence can infect decrease the sperm motility, 2-4 days are adequate for good sample.
Taking progesterone injections after IVF is better than vaginal pessaries of progesterone.
FACT-> Progesterone injections are painful. They do not have any advantage over vaginal pessaries.
Housework and cooking are prohibited after IVF.
FACT-> Housework, cooking, bending, sleeping on stomach and mild exercise such as walking are all permitted after IVF.
Complete bed rest is required for all patients following IVF.
FACT-> Women can and should live a normal life after doing IVF.
IVF increases the risk of cancer, particularly of breast and ovaries.
FACT-> There are several studies that have shown no increased risk of cancer after IVF.
IVF makes you put on weight.
FACT-> The hormones may cause water retention but does not lead to weight gain by accumulation of fat.
PCOS goes away after having a baby.
FACT-> PCOS is a condition that has a genetic basis. It does not go away by itself. Treatment needs to be continued.
A Retroverted uterus causes infertility.
FACT-> A retroverted uterus is present in about 30% of women. As long as it is not fixed in the r/v position, it does not impact fertility.
IVF is completely unnatural.
FACT-> IVF mimics nature and the seven steps of fertilization. The culture medium, incubator and processes are made as close to nature as possible.
- Published in IVF
Fertility Issue is a growing battle which costs tonnes of money. Most important 100% success rate has not been achieved, so many couples require more than one cycle adding to financial burden.
In India, as compared to other countries like UK and US, the charges for IVF treatment are very less. We get a lot of patients from Australia, Canada because they get the same world class facilities at lower cost. But still these may be unaffordable for a section of Indian Population. Infertility Treatments are also not covered under Insaurance Policies.
We believe that everyone should have the oppurtunity to have a family without financial concerns. To deprive a patient of these services merely because they cannot afford is not a right thing. Keeping this in mind we have started Budget IVF.
In BUDGET IVF whole procedure is same except that the stimulation protocol is more simplified. There is less hormonal monitoring, we do ICSI instead of IVF in majority of cases where Indicated and cases are done in batches. All these reduces the cost to some extent and makes the financial issuses more comfortable for you.
There are certain criteria for BUDGET IVF :
Female age less than 35 yrs.
Normal Ovarian Reserve.
No Pelvic Pathology.
No Male factor associated.
In Budget IVF the IVF lab charges are reduced to Rs 50,000 and cost of Injections is also lessened.
The Aim of our Budget IVF is to make ART treatment affordable so that everyone has access to it.
- Published in IVF