In Perspective: History of Previously Unsuccessful IVF Cycles
Many patients come to RMA of New York after unsuccessful IVF cycles at other centers. They might have had a follow-up visit with their doctor and been told they are “poor responders” or have “implantation failure” and are concerned they may not be able to achieve their family building goals. At RMA of New York we provide a scientific, evidence-based approach to help determine the cause for their previously unsuccessful cycles and identify the best method to improve outcomes in future cycles.
An IVF cycle might have been unsuccessful due to female, male, or embryonic factors, or a combination of the above. IVF success is contingent on both the quantity and the quality of the eggs that can be retrieved. Some women with diminished ovarian reserve or advanced age may have difficulty responding to stimulation protocols and may not produce enough mature eggs for IVF. A personalized stimulation protocol is determined for every single patient based on their history and diagnostic work up. For example, estrogen priming or microflare Lupron protocols may be used to improve the number of eggs that can be retrieved in a low responder. Frequent monitoring during IVF stimulation is also used to determine the optimal time for the egg retrieval, when the majority of the eggs retrieved will be mature, to maximize the odds of achieving fertilization and subsequently having an embryo for transfer. Adjuvant treatments such as vitamin supplementation, DHEA, CoQ10, and acupuncture might also be suggested to improve egg quality in women with a poor IVF history.
In some cases, despite the number of mature eggs retrieved, many of these eggs do not fertilize into embryos. Poor fertilization rates may be a result of the method of insemination that eggs undergo. Traditionally, eggs were placed with sperm in a dish, a procedure called “conventional insemination.” However, for couples with a history of poor fertilization, intracytoplasmic sperm injection or “ICSI” can be used to increase fertilization rates by injecting a single sperm into an egg. At RMA of New York, fertilization rates average around 80% for all IVF cycles.
Sperm quality and quantity also plays a significant role in the likelihood of success with IVF. Poor semen quality (low number of morphologically normal sperm) or abnormalities in the DNA within the sperm may impact outcomes. Sperm function testing can be performed to determine whether treatment is needed to improve sperm quality, specifically sperm DNA integrity tests. These tests evaluate the overall state of DNA within the sperm and can guide future treatment options in the event that an issue or decreased DNA integrity is identified.
In some cases, eggs are successfully retrieved and fertilized but the embryo “arrests” or stops growing in culture. Embryonic arrest is believed to most commonly be a result of embryonic aneuploidy (an abnormal number of chromosomes) and therefore those embryos would not be viable even if they were to be transferred. The use of pre-implantation genetic testing for aneuploidy, or PGT-A, has been shown to improve pregnancy rates and reduce miscarriage rates significantly, but sometimes embryos are unable to reach the point of biopsy and chromosomal screening. In order to increase the likelihood that embryos can be tested, laboratory conditions are carefully monitored to minimize environmental stressors that may contribute to embryonic arrest. Culture conditions, temperature, humidity, pH and gas levels are all carefully regulated in the laboratory to ensure adequate growth and development of embryos. With optimal lab conditions, approximately 50-60% of embryos can be expected to develop to the blastocyst stage. Some embryos are also considered “slower growing” and may take longer to develop into blastocysts. While in many laboratories these embryos would be discarded after 6 days of development, at RMA of New York, extended culture until day 7 is used to allow slower growing embryos the opportunity to undergo biopsy for PGT-A and cryopreservation.
All of the providers at RMA of New York are very experienced in treating complex clinical conditions and patients with a history of poor IVF outcomes. At our center, your care will be personalized to your unique history, and we can learn from your previous IVF cycles, so that the right timing, medications, and protocols can be chosen to optimize your likelihood of success.