In-vitro fertilisation (IVF) offers hope to couples who are unable to conceive naturally, but its high success rate does not guarantee that you will conceive.
It is heartbreaking when IVF fails, and also, demoralising for couples. Failing with IVF does not mean you have to lose sight of your hopes for a child though. Your doctor and a fertility expert can guide you on further options.
One thing to note about IVF failures: it is not that uncommon to experience failure on the first couple of tries. However, it’s time to start taking measures if you fail for the third time. The first step is figuring out what could be causing the failure to get pregnant. You will be able to take the appropriate steps if you have details about both of your health conditions and the IVF process.
Why IVF fails
IVF failure can occur for two reasons: first, there is a problem with the embryo, and second, there is a problem with the couple. Repeated IVF failure is primarily the result of poor uterine condition, low egg and sperm quality, low embryo quality, and inappropriate embryo transfer.
A doctor will perform additional tests to determine the cause of IVF failure if the procedure fails more than three times despite the high quality of the embryos and good condition of the uterus.
The age of the mother is one of the most significant factors in IVF failure – the older the mother is, the lower the success rate for IVF. For 35-year-old women, the success rate of IVF is about 32%, while for those over 40, this number decreases to 16%.
Women over the age of 40 have a decreased ovarian reserve and a decreased response to ovarian induction drugs. This results in low quality eggs being retrieved from them, and thus, low grade embryos.
Additionally, women over the age of 35 are at increased risk of having embryos with chromosomal disorders. In addition to these factors, here are a few others that can cause the IVF treatment to fail:
- Endometriosis
- Genetic disorders in either partner that causes compromised gametes
- Polycystic ovarian syndrome (PCOS)
- Sperm quality issues due to obesity, smoking or drug abuse
- Egg quality issues arising from obesity
- Lifestyle disorders
- Poor uterus lining due to past infections or uterine damage.
In addition, pelvic infections can result in swollen Fallopian tubes, which prevent the embryos from implantation. Occasionally, the uterine lining does not accept the transferred embryos.
Managing IVF failure
Here are some tips to help you prepare your body and mind for repeating the IVF cycle after failure:
- Be prepared mentally and physically beforehand to repeat the IVF cycle if needed.
- Check with your doctor to find out how many times the fertility shots and ovarian punctures can be repeated (it is usually three to six times, depending on the condition of the ovaries).
- Be prepared to deal with the side effects of fertility drugs, such as pain at the injection site, breast tenderness, nausea, headaches, bloating, etc.
- Ask a family member or friend to help you inject the daily medications (if they know how to do so).
- Read more about the success rate of IVF (usually 30-40%) to be mentally prepared for any outcome.
- Take the fertility tests and fertility medication again; you may need to inject eight to 10 doses of drugs a day, but it will be worth it for a successful pregnancy.
- Avoid hot baths, swimming pools and saunas in the first days after a repeated IVF cycle.
- Have a realistic expectation of the treatment’s duration (it is usually two to three weeks for ovulation stimulation, sperm retrieval, fertilisation and embryo transfer).
- Support each other and have patience.
Other options
Based on your health, your doctor may suggest a few other options if IVF really doesn’t work for you:
> Third-party donor
Your doctor may recommend a third-party egg donor if there is any problem with the eggs. It is mainly recommended for women with inadequate, or non-viable, eggs. In this case, the eggs are obtained from donors after screening.
Third-party donors are usually under 30 years of age and have healthy eggs. Do note that in Malaysia, this option is not allowed for Muslim patients.
> One more attempt
In IVF treatment, you may need to try more than once in order to conceive. Only a few lucky ones succeed the first time around.
The doctor may recommend some tests for you and your partner before the second IVF treatment in order to rule out any conditions that may interfere with the procedure.
Also, they might suggest lifestyle changes to increase your chances of getting pregnant. If everything goes well, then they might suggest to proceed with another round of IVF.
> Surrogacy
Embryos cannot be fertilised by some women for a variety of reasons, including failed embryo implantation or repeated miscarriages. When that happens, surrogacy is the only option left.
These surrogates are merely gestational carriers for you and your partner, carrying the embryo for nine months – they are not directly linked biologically to the embryo. Malaysia does not have any specific law governing the issue of surrogacy.
However, any surrogacy agreement made between the commissioning parents and the surrogate mother may be rendered void under Section 24(e) of the Contracts Act 1950, if “the court regards it as immoral, or opposed to public policy”.
In conclusion
It can be difficult to cope with a failed fertility treatment. You can suffer mental health issues and financial hardship as a result.
Firstly, ensure that any underlying causes of infertility in yourself and/or your partner are treated first in order to optimise your chances of a successful IVF outcome.
And if at the end of the day, IVF truly doesn’t work for you, do remember that adoption can still be a viable option for becoming a parent.
By Datuk Dr Nor Ashikin Mokhtar
Published in Star Newspaper, 06 Mar 2023
