In vitro fertilization (IVF) has revolutionized reproductive medicine, offering hope to couples struggling with infertility.
However, despite advancements in technology and techniques, not all IVF cycles result in successful pregnancies. To understand this problem, examining the factors contributing to failed IVF cycles and exploring the clinical perspectives surrounding this complex issue is essential.
This article aims to provide real patient stories about failed IVF cycles but from the clinical point of view.
Throughout the article, we will see different factors contributing to failed IVF cycles, but want to keep in mind the list of the most common ones:
Ovarian Response:
The response of the ovaries to stimulation medications plays a crucial role in IVF success. We will explore how inadequate or excessive ovarian response can impact the outcome of the cycle.
Embryo Quality:
The quality of embryos produced during IVF is a vital determinant of success. We will examine how embryo morphology, genetic abnormalities, and other factors influence implantation and subsequent pregnancy rates.
Endometrial Receptivity:
The receptivity of the uterine lining to implantation is crucial for successful embryo implantation and development. We will discuss factors that may affect endometrial receptivity, such as hormonal imbalances or anatomical abnormalities.
Genetic and Chromosomal Factors:
Genetic abnormalities in either the embryos or the parents can contribute to failed IVF cycles. We will explore the impact of chromosomal abnormalities, genetic mutations, and preimplantation genetic testing on IVF outcomes.
Other Contributing Factors:
We will also consider additional factors that can influence IVF success, including an age-related decline in fertility, lifestyle factors, underlying medical conditions, and medication-related complications.
It is important to emphasize that each failed IVF cycle is unique, and individual circumstances can greatly impact outcomes. The purpose of this article is not to provide definitive answers but to foster a deeper understanding of the different nuances surrounding failed IVF cycles.
Real case studies presented below have been provided by the emBIO Fertility Clinic from Greece. All patients have been under the supervision of Dr Thanos Paraschos, medical director at emBIO.
Failed IVF Cycles and Successful Treatment Outcome in a Patient with Diffuse Adenomyosis
- 36-year-old couple
- BMI of 24
- Diagnosis of diffuse adenomyosis
- Two failed IVF cycles
What is Diffuse Adenomyosis?
Diffuse adenomyosis is a condition where the tissue that lines the uterus grows into the muscular wall of the uterus, causing it to become thickened and enlarged. This can lead to painful and heavy menstrual periods.
General Description of the Case
This case study revolves around a 36-year-old couple who sought fertility treatment due to difficulties in conceiving. The female patient had a diagnosis of diffuse adenomyosis and experienced implantation failure in previous IVF attempts. She had a BMI of 24 and a history of two failed IVF cycles. The male partner did not have any identified infertility issues, and his sperm test results were normal.
Previous Treatment Attempts
In her previous IVF cycle, the patient underwent a fresh cycle, producing 12 oocytes. Two good-quality 4AA blastocysts, one fresh and one frozen were transferred, resulting in negative outcomes.
Diagnostics
The female patient presented with symptoms of dysmenorrhea and hypermenorrhea. Diagnostic examinations revealed asymmetrical myometrial thickening predominantly in the anterior wall, with an ill-defined endo-myometrial junction, suggestive of diffuse adenomyosis. The patient also exhibited elevated cancer antigen 125 (CA-125) levels, indicating a potential impact on IVF outcomes.
Treatment Protocol
To address the challenges posed by diffuse adenomyosis, a segmented IVF protocol was employed. This protocol involves separating the oocyte retrieval and embryo transfer cycles, with all embryos being cryopreserved. Additionally, a gonadotropin-releasing hormone (GnRH) agonist was administered to suppress the adenomyosis before the frozen embryo replacement transfer (FERT).
Suppression of Adenomyosis with GnRH Agonist
Prior to the FERT cycle, the patient underwent a three-month pretreatment regimen of monthly GnRH agonist injections (Leuprorelin 3.75 mg). This treatment successfully reduced the CA-125 levels and decreased the volume of the uterus by 20%.
Results before Embryo Transfer
Under the GnRH antagonist protocol, the patient received daily injections of 225 IU of follicle-stimulating hormone (FSH). A GnRH agonist trigger was administered, resulting in the retrieval of 14 oocytes. ICSI was performed on 11 mature oocytes, with 10 fertilizing normally. Five blastocysts (two 4AA and three 4BB) were cryopreserved.
Embryo Transfer
A single 4AA quality frozen-thawed blastocyst was transferred during the FERT cycle.
Pregnancy and Outcome
Following the embryo transfer, the patient achieved pregnancy with a positive human chorionic gonadotropin (hCG) level of 76. She experienced an uneventful pregnancy and delivered a healthy male infant via cesarean section at 38 weeks of gestation. The baby weighed 2700 grams and exhibited no complications.
Final Word
This case study highlights the successful outcome achieved in a patient with diffuse adenomyosis following a segmented IVF protocol combined with GnRH agonist suppression.
The multidisciplinary approach utilized in this case, involving expertise in reproductive medicine and gynaecology, contributed to the positive results obtained.
It is essential to note that this case study represents a specific clinical scenario, and individual results may vary. The success achieved in this case underscores the significance of tailoring IVF protocols to address the unique challenges faced by each patient, particularly when dealing with conditions such as diffuse adenomyosis. Further research and exploration of personalized treatment approaches are warranted to enhance IVF success rates in similar cases.
Successful Treatment Outcome in a Patient with Endometritis and Recurrent Implantation Failure
- 35-year-old female patient
- BMI – 23
- Diagnosis of endometritis
- Recurrent implantation failure
- Three failed IVF cycles (two fresh and one frozen)
What is Endometritis?
Endometritis is a medical condition characterized by inflammation or infection of the endometrium, which is the inner lining of the uterus. It usually occurs after childbirth, miscarriage, or certain medical procedures involving the uterus. The inflammation can be caused by bacteria or other microorganisms that enter the uterus, leading to symptoms such as pelvic pain, abnormal vaginal discharge, and fever. Prompt medical treatment with antibiotics is necessary to resolve the infection and prevent complications.
General Description of the Case
This case study focuses on a couple where the 35-year-old female patient had a history of three failed IVF cycles (two fresh and one frozen), with recurrent implantation failure. She had a BMI of 23 and a diagnosis of endometritis. The 34-year-old male partner did not have any identified infertility issues.
Previous Treatment Attempts
The patient’s previous IVF cycles resulted in the transfer of three perfect blastocysts (4AA), all of which failed to implant. No ovarian reserve or sperm issues were detected, and the hysterosalpingogram (HSG) appeared normal. The patient still had one remaining frozen 4BB blastocyst.
Diagnostics
To investigate the causes of infertility and recurrent implantation failure, diagnostic hysteroscopy and endometrial biopsy were performed. Micropolyps were observed during hysteroscopy, indicating chronic endometritis. The endometrial biopsy revealed the presence of plasma cells, and the sample tested positive for CD138. Chronic endometritis was diagnosed.
The patient did not exhibit any specific symptoms, and a simple culture of vaginal and cervical fluid was negative. However, the ALICE test (Analysis of Infectious Chronic Endometritis) was employed to detect the specific bacteria causing the endometritis. Next Generation Sequencing (NGS) technology identified DNA from Streptococcus in a significant amount in the endometrial sample.
Treatment Protocol:
Targeted antibiotic therapy using Amoxicillin/Clavulanic acid (500-125 mg/8 h for 7 days) followed by probiotic treatment was recommended. Chronic endometritis, an infection of the endometrium, can negatively impact embryo implantation and cause implantation failure. After successful targeted antibiotic treatment, the remaining frozen 4BB blastocyst was transferred.
Results before Embryo Transfer
A single-thawed 4BB blastocyst was transferred during a natural frozen embryo transfer cycle.
Embryo Transfer:
The embryo transfer took place after the couple inquired with the clinic. The thawed 4BB blastocyst was transferred.
Pregnancy and Outcome:
Following the embryo transfer, a singleton pregnancy was confirmed, with a positive human chorionic gonadotropin (hCG) level of 92. The patient went on to deliver a healthy baby through normal delivery at 39 weeks and 2 days of gestation.
Final Word
This case study highlights the successful treatment outcome in a patient with endometritis and recurrent implantation failure. Through targeted antibiotic therapy, the specific bacterial infection causing the endometritis was identified and effectively treated, leading to a successful pregnancy and live birth. The expertise and knowledge of the treating doctor played a crucial role in diagnosing and managing this case.
It is important to note that each infertility case is unique, and individual results may vary. The successful outcome achieved in this case emphasizes the significance of accurate diagnosis and tailored treatment approaches for addressing underlying factors that contribute to implantation failure. Further research and advancements in diagnostic techniques and targeted therapies are essential to optimize IVF success rates in patients with similar conditions.
Successful Treatment Outcome in a Patient with Polycystic Ovaries and Poor Egg Quality
- 37-year-old female patient
- Male partner – 42 years old
- BMI – 26
- Polycystic ovaries and poor egg and embryo quality
- Two failed IVF cycles
What is PCO?
Polycystic ovary syndrome (PCOS) is a hormonal disorder that affects women of reproductive age. It is characterized by the presence of multiple small cysts (fluid-filled sacs) on the ovaries, along with hormonal imbalances.
In PCOS, the ovaries may produce higher than normal levels of androgens (male hormones), leading to various symptoms and reproductive problems. Some common signs and symptoms of PCOS include irregular or absent menstrual periods, excessive hair growth (hirsutism), acne, weight gain, and difficulty getting pregnant.
General Description of the Case:
This case study focuses on a 37-year-old female patient who faced difficulties conceiving due to polycystic ovaries and poor egg and embryo quality. Her BMI was 26, and she had a history of two failed IVF cycles. The male partner, aged 42, did not have any identified infertility issues.
Previous Treatment Attempts:
The patient underwent two IVF cycles. During the first cycle at the age of 35, she had 28 retrieved eggs, and during the second cycle at the age of 36, she had 25 retrieved eggs. Both cycles utilized the long agonist protocol with 225 IU of recombinant FSH. An HCG trigger was used in both cycles.
Unfortunately, most of the eggs were immature and of poor quality, with only four mature eggs and two poor-quality day 3 embryos produced. The patient experienced Ovarian Hyperstimulation Syndrome (OHSS) in both cycles.
Diagnostics
The woman was diagnosed with polycystic ovaries, which were identified through ultrasound. Additionally, she had high Anti-Müllerian Hormone (AMH) levels (6 ng/mL) and a high antral follicle count (40 antral follicles).
Treatment Protocol
A modified polycystic ovarian syndrome (PCOS) protocol was employed for the treatment. The protocol involved using a GnRH agonist trigger and the lowest possible dose of gonadotropins to minimize the risk of OHSS.
An antagonist (Cetrorelix) protocol with a minimum dose of 150 IU recombinant FSH was utilized. The final maturation of oocytes was triggered using a GnRH agonist (leuprolide acetate 2 mg) 36 hours prior to egg retrieval.
HCG trigger was avoided to reduce the risk of OHSS. The protocol followed a “Freeze All” approach, cryopreserving all embryos for future transfer in natural cycles. This approach aimed to collect mature and better-quality oocytes, resulting in improved blastocyst quality and reducing the risk of OHSS.
Results before Embryo Transfer
The patient exhibited an adequate response to the GnRH agonist trigger without needing retriggering. Sixteen eggs were collected, with 14 being mature (MII). Thirteen embryos were produced, and six blastocysts (three 4AA, one 5AA, two 4BB) were cryopreserved for future use. OHSS was successfully prevented.
Embryo Transfer
Two months later, a 4AA quality frozen blastocyst was transferred.
Pregnancy and Outcome
A singleton pregnancy was confirmed with a positive HCG level of 202. The patient delivered a healthy baby at 38 weeks and 3 days of gestation through normal delivery.
Final Word:
This case study highlights the successful treatment outcome in a patient with polycystic ovaries and poor egg quality. The utilization of a modified PCOS protocol, including a GnRH agonist trigger and low-dose gonadotropins, resulted in improved oocyte and embryo quality. The “Freeze All” approach reduced the risk of OHSS and allowed for the selection of a favourable endometrial environment for embryo transfer. The expertise of the treating doctor in managing PCOS and optimizing treatment protocols played a crucial role in achieving a successful pregnancy and live birth.
It is important to note that each infertility case is unique, and individual results may vary. The successful outcome achieved in this case highlights the significance of tailored treatment approaches and individualized protocols in addressing specific patients’ needs and challenges. The doctor behind the treatment in this case has expertise in managing patients with polycystic ovaries and optimizing treatment protocols to maximize success rates.
Following the treatment, the patient had a positive pregnancy test with an HCG level of 202, indicating a viable pregnancy. The patient successfully carried the pregnancy to term, delivering a healthy baby at 38 weeks and 3 days through a normal delivery.
This case demonstrates the importance of personalized care and a comprehensive approach in addressing infertility issues related to polycystic ovaries and poor egg quality. By modifying the treatment protocol and employing strategies to improve oocyte and embryo quality, the chances of a successful pregnancy were significantly enhanced.
IVF success stories – failed IVF cycles – final thoughts
It is essential to note that the success of any fertility treatment depends on various factors, including the specific circumstances of each patient. The expertise of the medical team, proper diagnosis, and tailored treatment plans all contribute to increasing the chances of a positive outcome. Understanding what to do after failed IVF treatment is crucial for individuals navigating fertility challenges.
Please note:
The case studies presented above are for informational purposes only and should not replace professional medical advice. The success rates and outcomes mentioned here are specific to this case and may not reflect the results of every individual undergoing similar treatment.
