What went wrong? Why did the IVF cycle fail?

In cases of failure of an IVF cycle, patients are naturally curious to know what might have caused the failure. However, this is where some IVF doctors go wrong. They interpret the patients’ inquiry into what might have gone wrong to mean that the patient is casting aspersions on their competence. They therefore resort to carrying out numerous medical tests in their endeavor to leave the patients satisfied that the doctor is trying to get to the bottom of the matter and a solution will soon be found. This is a sad fallacy.

Doctors order tests knowing full well that medical technology has its own shortcomings and that it is not always possible to ascertain the true cause of IVF cycle failure. A mature doctor should be able to face a patient and honestly explain to her that there is no technology in place that determines what happens to the embryo while inside the uterus after having been transferred.

Conversely, patients should be well-informed and be willing to listen to the truth that even in a perfect cycle , the chances of success are always less than 50% . This would help reduce numerous complaints about IVF doctors;  and save the patient’s time and money spent visiting IVF clinics in order to do expensive and unnecessary tests.

Donor egg IVF has a higher success rate than surrogacy

 Women feel much more connected to their embryos than to their uterus, so much so that they even refer to their embryos as “embies” since they ultimately develop into babies. This is unlike the uterus, which many women blame for a lot of things; from their menstrual periods ; to infertility; to miscarriages; and failed IVF cycles.

What many IVF patients fail to realize is that it's usually not the uterus which is at fault when an IVF cycle fails. It is because they harbour this delusion that patients who have failed IVF cycles decide to opt for surrogacy.

The reality is that when embryos do not implant, it is usually because of a genetic problem in the embryo, and nature prevents this embryo from implanting, so as to prevent the development of babies with genetic abnormalities. Even if these embryos were to be transferred to a surrogate’s uterus, the cycle would still fail. 
 These genetic abnormalities are much commoner in older women, because their eggs have aged.

There is always the possibility of using Comprehensive Chromosomal Screening (CCS), but this will not detect all the genetic defects in embryos . 

For most older women who have failed many IVF cycles, the option with the highest pregnancy rate would be to go in for donor eggs. However, they do not realise this, and when they seek a second opinion from another clinic, and ask for surrogacy treatment, most doctors are happy to do surrogacy for these patients, because this is much more profitable for them.

Patient complaints about IVF failure

Common patient complains about IVF treatment usually include : overcharging; running too many medical tests; not spending enough time with the patient; and not providing enough information.

In cases of IVF failure, patients can be quite vocal with their complaints because they feel they have been cheated. 

However, patients have a critical role to play in ensuring they get the best service delivery. 

Among the red flags that a patient must watch out for is failure by an IVF doctor to issue her with photos of embryos. This is because embryo photos are critical in ensuring the success of IVF. Consequently, when they come to Dr. Malpani for a second opinion concerning IVF failure, I will always remind them that it is their responsibility to demand photos of embryos.

That is not to say that I like criticizing my patients or talking ill of other doctors, but this is my way of empowering infertile patients to be proactive , and to seek as much information as they can , so as to clear any doubts about the quality of care they have received, so that they can get the best medical service. 

It is bad enough for any IVF doctor not to provide a patient with photos of embryo, but it is even worse for a patient not to be assertive and ensure she is given the photos!

However, if the doctor is not willing to share information with his patient, then the patient should look for another IVF specialist !

What you need to know about embryo transfer

Today I want to try and dispel some of the doubts and misunderstandings that many patients have about the embryo transfer procedure . This should help to reduce the tendency of patients calling IVF doctors a ‘cheat’ when the IVF cycle fails due to a lack of information . 

It is important to understand that there are 2 separate components of embryo transfer. The first component is mechanical in nature and it entails physically putting the embryo back inside the uterine cavity through the cervix using an embryo transfer catheter. The mechanics of the process are fairly easy and straightforward. Normally it is just a matter of a few minutes before the embryo transfer is complete and this is a process that is performed routinely in IVF clinics all the time. A good IVF doctor is skillful and will transfer the embryo gently. His patience also ensures that there is minimal damage caused to either the embryos or the uterus.

Interestingly though, there is marked difference in pregnancy rates of the procedures carried out by different doctors despite this being a fairly straightforward process. Recent reviews have shown that some doctors have as high as 3 times the success rate of their fellow doctors with whom they work in the same clinic and seem to perform the same procedure. We are yet to know why there is such a marked difference but this why I, Dr. Malpani normally advice patients that they should find a highly experienced doctor! This could significantly reduce patient complaints. It is still debatable whether or not the use of ultrasound by doctors to try and improve the results by guiding them in knowing exactly where to place the embryo is helpful to experienced doctors.

If you want a free second opinion, please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm so that I can guide you!

We have over 20 years of experience in providing IVF services. Taking treatment with us will maximize your chances of success and give you peace of mind you did your best !