Friday, 26 June 2020

Vol.16, JUNE 2020, Recurrent IVF failure: What to Do

Recurrent IVF Failure - What to Do

Mr J. Adeghe PhD, FRCOG., Consultant – Fertility & Gynaecology

St Jude Hospitals & Clinics, UK.

1. Attend for review with your Specialist/Consultant and ask specific questions:

  • His or her opinion on possible cause for treatment failure
  • What further tests should be performed to identify any underlying problems
  • Was the endometrial thickness adequate during treatment cycles?
  • Was embryo development and quality satisfactory
  • Was Blastocyst culture performed?
  • Would he / she consider referring you for a second opinion

2.   Lifestyle changes – it is very important to correct any unfavourable lifestyle features that exist

·        Stop smoking

·        Give up alcohol consumption

·        Achieve BMI <30 through diet control and exercises

·        Adopt good dietary plan – based on the Mediterranean diet

·        Reduce Stress in your life – at home and at work

3. Investigations to Consider:

  • Blood test for Thyroid Function - TSH, Thyroxine, Thyroglobulin Antibodies, Thyroid Peroxidase antibodies
  • Full Blood Count - Haemoglobin level and other blood indices
  • Blood test for Vitamin D & Calcium levels
  • Infection screen for Chlamydia, Gonorrhoea, Mycoplasma genitalium, Ureaplasma genitalia, Trichomonas vaginalis, Gardnerella vaginalis, Herpes Simplex I/II
  • Pelvic Ultrasound scan

4. Other Specialist Investigations to Consider:

  • Blood test for Immunological factor - Checking for Natural killer (NK) Cell activity
  • Laparoscopy to exclude Hydrosalpinx which will require Salpingectomy
  • Hysteroscopy to exclude endometrial polyp and also to take a biopsy to check for underlying inflammatory pathology
  • Uterine artery doppler studies – Poor uterine blood flow may be related to suboptimal endometrial thickening
  • DNA fragmentation test on semen sample – if sperm quality is poor

5. Treatment strategy:

·        A review of previous treatment cycles and results of investigations will influence the choice of treatment protocol:

a) Long protocol

b) Short protocol with agonist

c) Short protocol with antagonist

d) Elective freeze of all embryos and subsequent frozen embryo replacement (FET)

·        Depending on findings from previous treatment cycles, AMH result, and sperm quality, it may better to consider:

a)      Donor eggs

b)      Donor sperm

c)      Surrogacy

d)      Decide that further IVF cycles are unlikely to be successful, therefore Adoption should be considered


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Vol.16, JUNE 2020, Recurrent IVF failure: What to Do

Recurrent IVF Failure - What to Do Mr J. Adeghe PhD, FRCOG.,  Consultant – Fertility & Gynaecology St Jude Hospitals & Clinics, ...