By Dr. Kemi Ailoje
There is a high and similarly equal chance of success on the first three attempts at In-Vitro Fertilization (IVF) but if not successful, then a fourth attempt will offer little success unless there has been a major change in protocol, or the “environment” that the embryos are placed into is changed.
In spite of the fact that use of donor eggs is always an option, there is another and possibly very successful option to consider such as Zygote Intra-Fallopian tube Transfer (ZIFT) or Gamete Intra-Fallopian tube Transfer (GIFT). ZIFT is a procedure where your eggs are recovered and fertilized exactly the same as with In-Vitro Fertilization (IVF), but rather than keeping them in the incubator, they are immediately transferred back into the fallopian tube via laparoscopy within a day or two. GIFT is a procedure where the eggs are recovered by either Transvaginal aspiration or laparoscopy, immediately mixed with sperm and placed back into the fallopian tube, all within a matter of minutes. With GIFT, it allows procreation to occur in the body, which for some religious beliefs, is the only “allowable” means of advanced reproductive technology. It has been recorded that though, some religious sect are against all advanced reproductive technologies, including GIFT, and especially ZIFT and In-Vitro Fertilization (IVF); certain religion is in approval of the GIFT procedure, but not ZIFT and In-Vitro Fertilization (IVF). The reason to consider the option of either GIFT or ZIFT is the thinking that some embryos do better in the “natural environment” of the fallopian tube rather than the “artificial environment” of the incubator. It is thought to also allow further and more advanced development in the natural environment of the fallopian tube before entry into the uterine cavity, and more synchronization with the uterus, the presence of numerous growth factors in the human tubal fluid may contribute to the development of some early embryos and thus enhance implantation, and may reduce traumatic cervical transfer in some difficult patients.
When all factors have been considered and other options with IVF exhausted without success that is the ideal time to re-strategize.
Different treatment modalities have been recommended and attempted for unsuccessful In-Vitro Fertilization (IVF) to improve to greater extent the implantation in these patients. These include the options of Assisted Hatching(AZH) where a microscopic hole is made in the wall of the embryo to help it “hatch out” before implantation, embryo co-culture, Pre-implantation Genetic Testing for Aneuploidy(PGT A) where cells are removed, sent for genetic diseases and chromosomal disorders, this offers at risk couples the opportunity to select embryos for transfer with a normal number of chromosomes to achieve successful pregnancy, prophylactically removing the fallopian tubes in the cases of large hydrosalpinges or dilated water tubes, and more so extension of embryo culture to day 5 or blastocyst stage (Blastocyst Transfer).
It is unfortunate that all these factors cannot be considered on the first attempt at In-Vitro Fertilization (IVF) as they may all not be necessary for a patient to achieve successful pregnancy in the first IVF attempt.
Success has been recorded in some patients with clinically proven adjuvants for example the addition of Human Growth Hormone or hGH to the treatment protocol . It is a known fact that hGH is a co-gonadotrophin and, like FSH and LH, is absolutely needed for the full and final maturation of an egg. Although, if measured, a patient will have a normal level of hGH in the blood, some patients do not have enough hGH for all the extra eggs that they make. These patients are impossible to identify before procedure but young patients that make a lot of eggs and have poor fertilization rates or do not get pregnant as expected seem to have better success rates when hGH is added to their treatment protocol as part of their starting protocol for In-Vitro Fertilization (IVF). Some patients may also benefit from use of IVIg given before embryo transfer and a second dose when a fetal heart is noticed has been found to improve implantation and live birth and some Intralipid infusion. Others may benefit from immunomodulation therapy.
Finally, considering the high cost of IVF, it is normal to wonder if IVF will truly work out for you. The good news is that IVF is generally successful, especially for women under age 35 and those using donor eggs at older age. Success rates among women of all ages have been found to increase over three cycles.
Couple/couples presenting with Repeated Implantation Failure (RIF) represent a significant challenge for the treating clinic, it is important that a step by step approach to management be done with individualized treatment option to achieve pregnancy and healthy babies.
Failure can conjure a plethora of negative emotions – frustration, sadness, dejection and disappointment to name a few. It is normal to feel sad. Healthy even, for grieving your lost chance can help cleanse your mind and prepare you for what lies ahead.
Allow yourself time to heal before making any decisions about your next steps, and remind yourself that IVF isn’t always successful the first time around.
Many women conceive on their second or even third cycle. And although it’s hard to stay patient, sometimes, it is the only way to receiving a miracle.
Breaking a cycle of IVF doom and gloom can seem hard at first, but know that there is light at the end of the tunnel. With hope and patience, you’ll make it out of the other sure side of successful parenthood.
References: Cloudninefertility.com.acfc2000.com, lifelinkfertility.com