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Most difficult IVF patients (those with a poor prognosis) usually have just one problem - either poor eggs or a poor endometrium. Between a rock and a hard place - dealing with poor prognosis IVF patients

Most difficult IVF patients ( those with a poor prognosis) usually have just one problem -  either poor eggs or a poor endometrium. However some really unfortunate ones have a double whammy - they have both poor eggs as well as a poor endometrium. This often means that both doctor and patient are caught in a bind.

Read more- Oopause - poor ovarian response

The embryo freezing option 

If there had been a lot of eggs and a poor non-receptive endometrium , the simplest option would have been to freeze all the embryos ; and then work on improving the endometrium so that the frozen embryos could be transferred in a subsequent cycle after thawing them when the endometrium was ripe.

However if there are only a few eggs , we are likely to get only a few embryos, and often these may be of poor quality so that they may not survive the stress of a freeze and a thaw. Is a bird in the hand worth two in the bush ? 

  • One option is to cancel the cycle and then consider alternative options such as using donor eggs.
  • Another option is to accept the fact that the chances of implantation are poor because of a poor endometrium , but to go ahead with the transfer anyway in the fresh cycle.
  • The other option is to proceed with the egg collection ; and then make a decision whether to transfer or not , depending upon the number of embryos obtained and their quality.

Read more- IVF Procedure with Donor Eggs – Who is an Appropriate Candidate?

Difficult decisions

These are all difficult decisions which tax both the patient's emotional stamina and the doctor's clinical judgment. I feel the best approach is to make a list of all the options ; to try to quantify the probability of success with each option, using the doctor's best guesstimate; and then to allow the patient to make the final decision. Patients should follow the path of least regret , so they have peace of mind they did their best , even when the odds were stacked against them.

Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.

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