Thursday, 10 April 2014

IVF Failure - Answers to the Reasons

IVF is part clinical and part biological process. Although, few researches have marked the success rate between 40 and 50 percent but the response of every woman is different. So, individually it is difficult to predict if the woman would conceive in a particular IVF cycle or not. However, there are certain defined parameters that might hint the doctors about the chances of success including the Ovarian Reserve.

It has been explained ovarian reserve play a vital role in predicting the chances of success. Women with higher number of quality eggs left in their ovaries (which is generally in younger women) are more likely to conceive with the IVF. Women, in their growing years lose the quality eggs during menstrual cycle, so older women have poor ovarian reserve.  

Why women have poor ovarian reserve?

Women have poor ovarian reserve, also called Diminished Ovarian Reserve (DOR), when the number of potential eggs in her ovary gets exhausted with age and the remaining eggs do not have capacity to turn into an embryo. Such a condition is detected in women who are above 40 years of age and are 6 to 8 years away from menopause. Unfortunately, few women experience the condition of poor ovarian reserve much before the expected age. Most of the time, it is impossible to predict the reason behind premature ovarian aging, it might be genetic. Or else, doctors consider the following additional grounds for the above condition.

•    Mutation in genes
•    Autoimmune disorders
•    viral infections
•    Chemotherapy or radiation
•    Surgery on the ovaries to remove cyst, or to remove endometriosis implants

Ovarian Reserve testing

Women need to get their Ovarian Reserve tested before undergoing IVF. There are three ways -
  1. Testing Anti-müllerian hormone levels (AMH) in blood on any day of your menstrual cycle.
  2. Testing FSH and e2 levels in blood, measured on day 3 of your menstrual cycle.
  3. Antral Follicle Count (AFC) – scanning your ovaries using a vaginal ultrasound probe on day 1-5 of your menstrual cycle.

 Why poor ovarian reserve reduces IVF success?

The AMH level testing gives an account of number of anthral follicles in their ovaries. Lesser the number of anthral follicles poorer the ovarian reserve. This is because anthral follicles are stimulated during IVF to produce eggs. Lesser follicles produce fewer eggs and so the chances of IVF success get reduced.
Women above 40 years of age usually have genetic problems like aneuploidy, which means poor quality eggs. Lesser potential eggs fail to implant in the uterus.  

Is it possible for a woman with poor ovarian reserve to have her own genetic child?

There are two factors that jointly contribute in a successful IVF cycle. First, quality of eggs and second is quantity. Unfortunately, older women are deficient in both of these. The chances of conceiving in younger women with poor ovarian reserve are higher than the older ones. Because, younger women might have poor ovarian reserve but the eggs (even if less in number) are of good quality. So, less number of Grade A eggs is better than higher number of Grade B or C eggs.

We in Pahlajani IVF Clinic suggest the patient with poor ovarian reserve to undergo at least IVF cycle by stimulating your own ovaries and take the alternatives depending on the results. Since the process is not predictive, there are chances of successful IVF cycle too. It has been observed that women with good AMH levels respond poorly to ovarian stimulation - and vice versa.

So, believe in the tradition theory, as long as you produce eggs, you have genuine chances of becoming pregnant. After one IVF cycle, the picture becomes clearer and if you fail to produce required number or quality of eggs then you might consider the option of using donor eggs. There is no less option! So it is wise to be patient and keeping your options open. 

Dr Neeraj Pahlajani

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