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.

The stem cell scam for patients with premature ovarian failure

While many patients with ovarian failure understand that their best shot at having a baby is by going in for donor eggs, some of them never contemplate selecting this option for varied reasons. Muslim women for example cannot choose this option because it is against the doctrines of their religion. However, this is where unscrupulous doctors come in take advantage of patients’ desperation to milk them with no results to show for it.

I had an encounter with a patient who visited such a doctor in India with the hope that she would be able to get a baby from her own eggs. She had been lied to by the doctor that she was going to get pregnant once stem cell therapy had been carried out. After several very expensive injections of " embryonic stem cells " into her blood, she was happy when the doctor did an ultrasound scan to show her that her ovaries now miraculously had eggs ! According to that doctor, the stem cells were to supposedly travel to her ovaries and transform into eggs, after which she could go in for IVF with her own eggs.

I can only imagine the patient’s agonizing heartbreak when she found out that the whole thing was a scam and that she could never get pregnant. For a patient who had travelled to the US and UK in search of treatment (where they told her to go for a donor egg); and having spent so much money without success, it is sad that patients are still so vulnerable to quacks; and that there still exists such heartless doctors who prey on patients’ lack of information . It is doctors like this who cheat patients who tarnish the name of the entire medical profession.

Why good IVF doctors do only IVF (and nothing else)

While every IVF specialist is equipped with the requisite knowledge in gynecology and obstetrics, IVF is a very specialized branch and that is why IVF specialists worldwide should stick to doing only IVF and not try to multitask by doing hysterectomies and caesarean sections in order to increase their income.

Most IVF specialists the world over have dedicated their time, resource and energy to practising only IVF - this is a full-time job ! However, most Indian IVF clinics are run by general gynecologists. This implies that they practice IVF only on a part-time basis alongside with offering a host of other gynecological treatments. The end result is sub-standard IVF services to patients, mostly ending up in low success rates. IVF patients should therefore go for specialists who have dedicated all their time and energy in doing IVF because this means that they are passionate and confident in what they do without the fear of having high rates of failure and running out of patients.

Moreover, such dedicated IVF specialists have spent a lot of time in honing their skills and will offer personalized treatment, never leaving their patients complaining about being left in the hands of doctor’s assistants as they travel abroad in search of more money from other patients. Patients should therefore review their options before they choose an IVF doctor instead of airing complaints about having been heated because they failed to do their homework in searching for competent IVF specialists. 

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 !