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(Wednesday, July 30, 2014)
Patients who have failed an IVF Cycle are often understandably desperate. It can be hard to come to terms with this failure, because most were very sure they would get pregnant in their very first attempt (few patients would have the courage to start an IVF cycle if they did not secretly believe in their heart of hearts that it would work for them!) They start hunting for solutions to increase their chances of success in their next IVF cycle.
Most will have had good embryos and an easy embryo transfer. When the cycle fails, it’s obvious that the reason for the failure is that the embryos did not implant – what is grandly called – “failed implantation”. The logical solution is then to do something to get them to stick – perhaps some kind of embryo glue which will make sure the embryos don’t fall out after they are transferred?
Sophisticated patients and doctors might find it amusing when the patients express her desires in these simple terms. This is because many people still have lots of misconceptions and myths about the entire process of what happens to the embryo once it is transferred into the uterus.
The truth is that most good looking embryos do not implant, and we know that the commonest reason for Failed Implantation is that there is a genetic problem in the embryo. This is often not something which we can diagnose, even with today's advanced genetic technology, which uses whole genome testing, array CGH and Next Generation Sequencing (NGS) . This is because embryos, which appear are normal on genetic testing may still have lethal genetic anomalies which we cannot pick up. Our genetic tests are still fairly crude, and only allow us to count the number of chromosomes. We still cannot analyze individual genes.
Embryo implantation is a complex process which depends on many variables. Along with the embryo, the uterine lining plays a key role as well, and this is affected by multiple complex variables, including: the blood supply to the endometrium; the hormone receptors in the endometrium; and the complex crosstalk between the embryo and the endometrium. The problem is that most patients don't understand a lot of this, and doctors don't bother to explain this to the patient. This is why many patients jump to the conclusion that the reason they Cycle Failed even though the doctor carefully deposited their beautiful embryos inside the uterus with the help of ultrasound guidance, was that they must have done something wrong which caused embryo to get dislodged.
- Perhaps they put too much pressure on the uterus by lifting a bucket?
- Or did going through that big pothole cause the embryos to fall out?
- Was their diet too hot?
- Or did they not rest enough?
Hundreds of doubts plague them, and it’s hard to find straight answers. They are very reluctant to ask their doctor, their questions, because they feel these are “stupid”. Also, bulletin boards are full of misinformation and myths.
We need to keep on reminding women that medical science has its own limitations, and we don’t know why embryos do not implant. Some doctors try to distort the truth by saying – “I made perfect embryos for you. The failure suggests there is something wrong with your body. Perhaps it is rejecting the embryo, because you have some kind of immune dysfunction”. This “explanation” makes sense to the patient, even thought it was completely false!
They will then spend lots of money and time and energy on testing for these immune dysfunction problems and even " treating " them . All of this might seem extremely medically sophisticated, but these tests are just as useless as thinking that the embryo got dislodged because the patient coughed or sneezed after the embryo transfer.
The honest doctor will tell the patient that once we have transferred the embryos into the uterus, this is now a “black box” area - a non-man's land. While we do our best to facilitate implantation (for example, by providing luteal phase support with estrogen and progesterone), we still cannot control biological processes. This is often a matter of luck, but patients don't want doctors to use terms like fate or chance or destiny. They crave certainty and when a doctor tells them the unvarnished truth, they get upset and go hunting for another doctor, who will pacify them by providing them with a pseudoscientific explanation for the failure by invoking scientific garbage such as the presence of a. “Pregnancy destroying factor” in their body which needs to be “treated “!
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