Grief counseling
After a failure the first thing that comes to you is why? Why did it fail. and why did it have to be you? While a fertility counsellor cannot answer the former, they can certainly help you deal with the second. They can stop you from blaming yourself or your partner and help you channelise the anger and frustration in a positive way. Yes, it is important to grieve, and your counsellor will help you to grieve without drowning in it. Not handling your grief in the right way can do more harm than you may think. The pain can be so intense that it gives way to anger and mistrust and doubt. Which is unusually directed at the doctor and clinic. When anger takes centre stage , you may not listen to what your doctor has to say after a failure. You may be missing out on what you can do to succeed in the next attempt. This can set you back even further on your parenthood journey. Listening to your medical team, asking the right questions is the single most important thing to do that will help you take the next step forward on your fertility journey
A fertility counsellor acts like the emotional buffer between you and your doctor. It is advised to take a week to deal with the pain of failure and talk to a negative counsellor as soon as you can. Studies show that couples who seek counselling during their treatment especially after a failed cycle are more likely to come back for another attempt and more likely to become parents sooner than those who don’t seek emotional support. This will help you set the right attitude to look for what comes next which is:
- Talking to your doctor to understand what went wrong
- And find out what you can do to improve the odds in the next attempt
Reasons for failure
Before exploring further treatments, it’s valuable to understand why the initial attempt might not have been successful. Discussing this with your doctor can shed light on potential factors contributing to the outcome. Here are some common reasons for unsuccessful fertility treatments:
- Chance element: Even in ideal circumstances, fertility treatments have a percentage chance of success. onely 4 in 10 couples undergoing IVF will succeed in the 1st attempt. For most couples it takes multiple attempts. Even in a natural pregnancy the chance of a couple conceiving in a cycle is around 15-20%. While IVF can help improve the chances of conception, a lot of it is still in the hands of nature.
- Problems with the yield of Eggs: Problems in the yield of oocytes is a common issue in women with poor ovarian reserve and it is very difficult to predict the response to ovulation induction. You expect around 20-25 eggs but the actual no of eggs retrieved may be far less. Out of the eggs retrieved not all of the eggs are of good quality so the number of embryos formed may be far less than the number of eggs retrieved. This is called the egg loss funnel, and this can be difficult for couples to accept, that in spite of taking fertility medications to increase their oocyte count you only get 2 or 3 embryos. Usually if there is a good yield of eggs, it is preferred to grow them till day 5 or blastocyst stage to allow the process of natural selection to filter out any poor quality embryos, as any poor quality embryo will not make it to blastocyst stage. With fewer embryos to pick and choose from, doctors have no option to transfer the embryos on day 3 and hope for the best.
- Poor quality of oocytes and sperms: The quality of the egg and sperms also significantly impacts the chances of success in one attempt. There can be significant amounts of DNA damage in the sperms and eggs, especially seen in couples over the age of 35, which can be passed on to the embryos which are unviable and may fail to implant or be miscarried.
- Problems of the uterus: Uterine abnormalities like endometriosis, adenomyosis, fibroids, walls or septums, uterine infections, pelvic inflammatory disease, Poor endometrium or thick endometrium, damage to uterine wall due to surgeries of infections in the past all contribute to the causes of implantation failure.
- Displaced Window of Implantation – One in 4 women have a displaced window of implantation leaving them with implantation failure. Which means the uterus is not ready to receive the embryo at the time of implantation
- Poor Embryo Quality : Although embryo grading is done to identify good looking embryos in standard IvF protocols, looking at an embryos under the scope cannot really tell you abouts its genetic constitution. An embryo may look good but may be having genetic defects making it unviable.
- Autoimmune problems: The uterus is an immune privileged organ designed to accept the embryo as its own. But in some cases, this body’s immune system doesn’t recognize the embryo as its own and attacks it.
- Treatment selection: The chosen treatment might not be the most suitable for your specific cause of infertility. In women with Tubal blacks IUI is not the right treatment approach. In women with diminished ovarian reserve , Oocyte donation might be a better approach. But in most cases, due to financial considerations, resistance from couples in accepting oocyte donation, or insistence on behalf of couples to try IUI, the right treatment approach offered, may not always be the first choice for couples.
- Using Standard Medication Protocol : Medication protocols have been standardised over the years by observing which dosage of medication works best for most women. This works in 70% of cases. But in some cases women may need a different or stronger protocol and in their case the ovulation induction protocol needs to be customised. This can be due to the poor ovarian reserve, premature ovarian insufficiency , menopausal women, or women with advanced age.
How to improve your odds in the next cycle?
Depending on the cause of the initial failure and your individual circumstances, several treatment options may be considered. Here’s a breakdown of some common approaches:
- ICSI/ IMSI: Advanced Techniques for sperm selection and embryo selection can be used in conjunction with IVF for specific cases to improve the chances of fertilisation.
- Surgery: Treating underlying conditions like fibroids or blocked fallopian tubes may improve fertility. Your doctor may advise you to undergo a hystero-laparoscopy to remove any blocks or correct any problems inside the uterus like polyps, walls, adhesions etc.
- Donor Sperm/Eggs: Using donor sperm or eggs can be an option for some couples who have poor or diminished ovarian reserve due to advanced age, chemotherapy, or premature ovarian insufficiency.
- Surrogacy: Surrogacy is a good option for women who cannot carry out pregnancy due to problems in the uterus or have auto-immune problems where the uterus rejects the embryos as a foreign body.
- PGT: Embryo biopsy before implantation can be done to identify genetically normal embryos for transplant.
- Endometrial Receptivity Array, can help identify any displaced window of implantation and help your doctors time the transfer when the endometrium is receptive.
