from
the book How to Have a Baby: Overcoming Infertility
by Dr. Aniruddha Malpani, MD and Dr. Anjali Malpani,
MD.
Previous page:
Test Tube Babies - IVF & GIFT (Page 3)
Next page: Test
Tube Babies - IVF & GIFT (Page 5)
Table of Contents
What
happens if the IVF cycle fails ?
Since most IVF programs superovulate patients to grow
many eggs, there are often many embryos. Since the risk
of multiple pregnancies increases with the number of
embryos transferred (and in fact the law in the UK prohibits
the transfer of more than 2 embryos to reduce this risk),
many patients are left with "spare" or supernumerary
embryos. These can be discarded; or used for research.
It is now also possible to freeze these
embryos and store them in liquid nitrogen. These stored
embryos can then be used later for the same patient
- so that she can have another embryo transfer cycle
done without having to go through superovulation and
egg collection all over again. Moreover, since this
embryo transfer is done in a "natural" cycle ( when
she is not taking any hormone injections ) some doctors
believe the receptivity of the uterus to the embryos
is better. For women with irregular menstrual cycles,
frozen embryo transfer can also be done in a " simulated
natural cycle", in which the endometrium is primed to
maximize its receptivity to the embryos by using exogenous
estrogens and progesterone.
Since pregnancy rates with good-quality
frozen-thawed embryos are as good as with fresh embryos,
we encourage all our patients to freeze and store their
supernumerary embryos, rather than discard them. Freezing
is very cost-effective, since transferring frozen-thawed
embryos is much less expensive than starting a new cycle,
so that it serves as a useful "insurance policy" in
case pregnancy does not occur. However, since it is
worthwhile freezing only good quality embryos, the option
of freezing is a "bonus" which is available to only
about 30% of all IVF patients.
About half of all embryos frozen survive
the freezing -thaw process. It is reassuring to know
that the risk of defects is not increased as a result
of freezing. These frozen embryos can be stored for
as long as is needed - even for many years. When they
are in liquid nitrogen, at a temperature of -196 C,
they are in a state of suspended animation, and all
metabolic activity at this low temperature stops, so
that a frozen embryo is like Sleeping Beauty !
Once stored, embryos can be used by
the couple during a later treatment cycle, donated to
another couple or removed from storage. These options
should only be undertaken after considerable discussion
and written consent from the parties concerned.
Fig 6. The Programmable embryo freezer. You can see
the liquid nitrogen vapours clearly.
While we still cannot freeze unfertilised human oocytes
efficiently, a new technique called vitrification (
which uses ultra-rapid cooling together with an increased
concentration of cryoprotectants ) may allow us to offer
this option to our patients, in the future, allowing
the facility of egg storage and egg banking.
What happens if the IVF
cycle fails ?
If you don’t get pregnant after your IVF attempt, you
are likely to be very disappointed and disheartened.
However, remember that this is not the end of the road
- it’s just the beginning ! At the end of the IVF cycle,
you need to sit down with your doctor and analyse what
you learnt from it. Was the ovarian response good ?
Was the endometrium receptive ? Did fertilisation occur
? Was the embryo transfer easy and atraumatic ? Why
didn’t pregnancy occur ( the million dollar question,
though this is usually a question we still cannot answer
!) Can you repeat the same treatment, or do you need
to make changes before going in for your next attempt
? When can you go in for your next IVF cycle ? And even
if you do not get pregnant, at least the fact that you
attempted IVF should give you peace of mind that you
tried your best , using the latest technology medical
science has to offer.
Most doctors would advise you to wait for a month before
starting a new cycle. While it is medically possible
to do the next cycle immediately, most patients need
a break to marshall their emotional strength before
starting again. Your doctor may need to modify your
treatment, depending upon an assessment of your previous
cycle. For example, if the ovarian response was poor,
the doctor may advise you to increase the dose of drugs
used for superovulation. If fertilisation did not occur,
you may need to go in for microinjection ( ICSI). If the quality
of the embryos was poor, you may be advised to consider
a ZIFT ( ZIFT Video ) rather
than IVF. ZIFT will also be advised if the embryo transfer
was difficult and traumatic, as this allows us to bypass
the cervix and transfer the embryos directly into the
fallopian tubes. However, if the cycle was satisfactory,
the doctor will often advise you to repeat exactly the
same treatment again - and all that it may take to achieve
your IVF success is time, patience, and another attempt.
Interestingly, we often find that couples
going through a second IVF cycle are much more relaxed
and in control. This may be because they are aware of
all the medical and procedural minutiae, and are better
prepared for these; and also because they have had a
chance to establish a personal relationship with the
medical team. Also, since they have already faced failure
the first time around, many of them are much better
able to cope with the stress of IVF, since they are
prepared for the worst. With today’s IVF technology,
we can confidently reassure any patient that we can
help them to get pregnant, provided they have inexhaustible
resources of time, money and energy !
continued
. . .
Next page: Test
Tube Babies - IVF & GIFT (Page 5)
Previous page:
Test Tube Babies - IVF & GIFT (Page 3)
Table of Contents
|
