IVF, ICSI Failure - Treating Failed In Vitro Fertilization - what is IVF Failure

In short: The most common reasons for IVF failure are embryos that do not implant, chromosome errors that cannot be seen in embryos that look healthy, and a poor ovarian response. To improve the next attempt the stimulation protocol may be changed, a trial transfer done and embryos transferred on day 5; some additional techniques may be discussed in selected cases, although the evidence for them is still limited.

It refers to infertile patient who have undergone many IVF cycles and produced good embryos but the embryos have failed to implant for unexplained reason

Methods to improve success in IVF failure

• Number of embryos: In selected difficult cases (for example older women with lower-quality embryos) two embryos may be transferred after discussion, but transferring more does not increase the chance of a baby and mainly increases the risk of multiple pregnancy.

Multiple pregnancy carries real risks for the mother and babies, including premature birth, even in difficult cases; fetal reduction is not a safe solution, so the aim is to avoid multiple pregnancy by limiting the number of embryos transferred.

• Adjusting stimulation: The protocol and dose may be adjusted for patients with a poor ovarian response, but studies show that very high doses (more than about 300 IU daily) do not increase the chance of a baby, so doses are tailored rather than simply increased.
• Difficult embryo transfer: That’s why we do artificial transfer for each patient by inserting a catheter into the uterus to measure its length and depth to know where to insert the embryos.
• PCOD (Polycystic ovarian disease):For these patients, ovulation induction is done carefully to have an average number of follicles only so we don’t end up by super ovulating them. [OHSS is reduced by using an antagonist protocol with lower doses, triggering final egg maturation with a GnRH agonist instead of hCG in high-risk cases, and freezing all embryos for a later transfer.
• Chromosomal abnormalities:It has been found that chromosomal abnormalities can be found in 50% of embryos even in good-looking ones.

Recommended tests after repeated IVF failure include a chromosome test (karyotype) for both partners, assessment of the uterine cavity (3D ultrasound or hysteroscopy) for polyps, fibroids, adhesions or hydrosalpinx, thyroid function and antiphospholipid antibodies, and a review of lifestyle factors such as smoking and weight.

• Blastocyst transfer (Rather than transferring them on day 2 or 3): About 40–60% of fertilised eggs reach the blastocyst stage in a good laboratory. Blastocyst transfer helps select the embryos most likely to implant, although for women with very few embryos an earlier transfer may be discussed.

For more on how embryos are grown to this stage, see our article on blastocyst (day-5) transfer.

• Immune system (ANA, APL antibodies, NK cells, antithyroid antibodies): Sometimes, an immune system can have a bad effect on an individual by different mechanism and can cause infertility and recurrent pregnancy loss, but abnormal results are often found in normal fertile women as well, and immune treatments (such as steroids, IVIG or intralipid) have not been shown to improve live birth rates, so they are not recommended by ESHRE (2023) outside research studies; testing for antiphospholipid antibodies and thyroid function remains useful.
• Thrombophilia: Thrombophilia is a condition that increases the chance of blood clotting. It has not been shown to cause implantation failure, and heparin or aspirin are not recommended for IVF failure unless there is a proven indication such as antiphospholipid syndrome or a previous clot (ESHRE 2023).
• IMSI (Intracytoplasmic morphologically-selected sperm injection)

IMSI uses a very high-powered microscope (about 6,000 times magnification, compared with about 400 times in standard ICSI) to select sperm with the best shape for injection. It may be considered in selected couples, for example with severe sperm abnormalities, but current evidence (ESHRE 2023) has not shown a routine increase in live birth rates.

Many patients have finally conceived after multiple IVF attempts even though there was no change in treatment protocol in all IVF clinics so sometimes it just needs a bit of luck, patience and perseverance.

Dr Najeeb Layyous F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist