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Failed IVF

“This time we almost made it”(But we didn’t so we’re going to try again.)

Once the sadness and anger over a failed IVF cycle have been addressed it is not uncommon for the disappointed couple to want to begin a new treatment cycle with the onset of the next “Day One”.In part this is a good thing: with the passage of time a woman’s eggs age and her chances of having a successful pregnancy diminish so waiting six months or a year to initiate a new cycle may considerably lower her chances for success. In addition studies have shown that embryo quality, implantation rate, and percentage of ongoing pregnancy are not compromised if IVF cycles are initiated back to back. Psychologically, “getting back on the horse” right away is purposeful, proactive, and, hopefully, productive.

Before beginning the next round of treatment it is essential that the couple consult with the physician to review, in detail, the previous failed cycle. Were there an adequate number of days of stimulation? Was follicular growth synchronous? Was the HCG trigger timed correctly? Was there anything that the physician would do differently on a subsequent cycle?

The lab data should be scrutinized as well: fertilization rate,embryo grades,timeliness of compaction, percentage of embryos reaching the blastocyst stage and the number of cells in the stem cell masses are some of the parameters assessed.

Once the clinical and laboratory aspects of a cycle have been reviewed a decision can be made as to whether another try might be more fruitful.

But how many cycles are appropriate? If IVF doesn’t work at what point should one stop cycling and discuss other options for parenthood? Too often patients get so caught up in the process that IVF becomes – well – like taking one’s chances at a slot machine: Let’s say that it takes 3 cherries to win the jackpot. You pull the handle -no cherries – so you try again: 1 cherry. You use another quarter and pull again: 2 cherries – and you get a small return of quarters. You have covered your “expenses” and have even made a few dollars’ profit. At this point it would be prudent to walk away with your cash but the last round with 2 cherries lures you into trying again. After all, 2 cherries is almost 3.

Not So. And like repeated pulls of the slot machine arm each cycle of IVF is an independent event and each sperm-egg combination is unique. Having a chemical pregnancy as a result of IVF is no better or “closer” to delivery than a complete failure of implantation. That said, a woman’s response to ovarian stimulation is pretty consistent cycle to cycle (at any one age) and if an ongoing pregnancy is not attained after two well-executed cycles another cycle of the same may just be a waste of money, time,and emotional energy. At this point swapping out eggs or sperm or both (ie donor gametes) or further investigating the uterus to make sure that it is a hospitable place for embryo development are options that should be given strong consideration.