Why you may not get eggs during your egg collection

Egg collection is a common procedure in IVF clinics. However, at times, the doctor may fail to collect any eggs at all because of the following five reasons:

1. The rupture of the follicle prior to egg collection due to poor timing of HCG injection or a delay of more that 36 hours in egg collection may cause eggs to be lost in follicular fluid in the pouch of Douglas, so that the doctor cannot find them.
2. Technical difficulties during egg collection such as obesity of the patient or adhesions in the pelvic region making ovaries inaccessible with the vaginal ultrasound probe. This is common in cases where the doctor is inexperienced and the patient cannot sustain pain or tolerate vaginal manipulations without anesthesia.
3. Failure by the doctor to use double lumen needle for flushing each follicle scrupulously . This means that even though there is an egg, the doctor may fail to retrieve it 
4. Inexperienced embryologists doctors may not see the egg within the oocyte cumulus complex even when it is there
5. Due to empty follicle syndrome. Read more here http://blog.drmalpani.com/2011/06/what-is-empty-follicle-syndrome-why.html

        These problems are far commoner in clinic where IVF  patients are treated as a batch and not not given close attention or monitoring at a personal level.

It is important for patients with diminished ovarian reserve to find an experienced doctor who collects eggs under anesthesia, using a double lumen needle.

Your IVF cycle failed. What next?

Patients’ hopes are quickly dashed and pessimism sets in when their IVF cycle fails and they understandably turn to their doctors for an explanation. Some doctors will carry out a battery of tests in their endeavor to satisfy the patient that all will be well once all the tests are done. At times patients and doctors follow their instincts and patients are introduced to treatments such as immune therapy for treating abnormal NK cells or anti TB for a positive PCR.

The truth is that at times it is not possible to point out exactly what causes IVF cycle failure. Although there are a few exceptions such as when there is a thin uterine lining or poor ovarian response, the truth is that in most cases it is simply not possible to point out the exact cause.

The human reproductive system is dynamic and often surprises even experts. For example, embryo transfer can be a challenge due to excessive bleeding ; or a patient may have poor quality embryos , but she surprisingly gets pregnant , while a perfect IVF cycle with excellent embryos may fail. 

There is simply no doctor in the world that is able to determine the fate of embryos once they are transferred to the uterus.

What are your choices if your cycle fails ? You may choose to repeat the cycle if it was perfect - or you may want to change something. 

Possible things you can change include: 

donor sperm, 

donor egg, 

surrogacy, 

donor embryo, 

the superovulation protocol - or,

the doctor. 

Ultimately, the best way is to be prepared emotionally for failure . This will enable you to handle the emotional distress that follows IVF cycle failure. This also reduces unjustifiable complaints about doctors and clinics.

Why did my embryos not implant?

Patients want to know the reason(s) why their IVF cycle failed and the most common answer they get from doctors is “implantation failure”. However, patients should never get satisfied with such an answer because it is a meaningless term that could have numerous interpretation:

Did embryo development arrest in the uterus ?
Did the blastocyst fail to hatch from the zona ?
Did the endometrium fail to produce the right chemical signals to allow embryo attachment?
Was the uterine blood supply inadequate for nourishment ; or 

Was there a genetic problem with the embryo ?

The term “implantation failure” is just medical jargon - a wastepaper basket diagnosis, that does not explain the exact cause of failure of an IVF cycle. The reason for this is that today's medical technology is unable to determine what happens to an embryo upon its transfer to the uterus. At an IVF clinic, we are only able to study :

the quality of the embryo before we transfer it;

the ease of the transfer procedure ; and 

the uterine lining.

We cannot track its fate after we have transferred in into the uterus.

However, patients should not lose hope just because an IVF cycles fails. They should also not be misled into carrying out a large number of expensive tests that will only serve to cost them more money and time and lead to even more frustration , mismanagement and complaints. 

Instead, they must realise that the human reproductive system is dynamic ; and that the failure of the first IVF cycle does not mean subsequent cycles will also fail.

IVF failure stories

The large majority of IVF websites are filled with IVF success stories ; typically first hand account of patients who share their happy experiences with the world after having successfully become pregnant via IVF. Such testimonies are very important because they give hope to other couples who were not blessed with a child and are exploring their options. However, of equal importance are IVF failure stories, which most IVF websites never post for patients.

Such stories would enable patients who were not lucky to have a baby via IVF to cope with their status and more importantly equip them with appropriate knowledge and skills to deal with such occurrences.   It is also worth noting that patients who were never lucky with IVF are never willing to share their stories because they see themselves as failures whose dreams of having a baby have been shattered. It is therefore important that such patients realize that with IVF, the chances of success are never 100% and that the failure of an IVF cycle does not mean the end of the world and that you will never have a child.

The problem is that most clinics fear publishing IVF failure stories . They are worried that this would discourage patients and drive them away to their competitors. I, Dr. Malpani beg to differ. I believe that most patients are smart enough to face the truth and a clinic that publishes IVF failure stories would command a lot of respect - unlike those that only paint a rosy picture about the process, only for patients who fail to be disappointed and then express lots of complaints and write negative reviews about the IVF clinic.

We all learn from experiences - and both IVF failure stories and IVF success stories have a lot to  teach us !

The second IVF baby

Upon having their first child via IVF, most infertile couples are understandably relieved and are filled with so much happiness that they feel their family is complete. They find their first child completely fulfilling, and do not even dream of having another baby.

However, about five or six years later, the very couple that successfully had their first child via IVF will walk into a clinic and give IVF another try, this time more enthusiastic and confident of their chances of success. Mostly, they explain that their first child is lonely and needs company.

Such patients need to understand that as much as their chances of their second IVF succeeding are normally high following the success of the first cycle, it does not mean that the second cycle has a 100% chance of succeeding. Dr. Malpani says the best approach would be to always plan for the future just after the successful completion of the first cycle by asking your IVF doctor to safely store the frozen embryos for you if you had arranged for them to be frozen. Those embryos are from the cohort that succeeded during the first cycle and therefore their chances of getting you a baby are high.

The most encouraging element of the IVF cycle however is that you will have established a good rapport with your doctor and you will know how to get him/her to adequately respond to your complaints and questions. Moreover, you will have lots of IVF knowledge carried over from the previous experience.