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IVF failure and what’s next? #IVFWEBINARS

What are the symptoms of IVF failure? And what are the reasons for IVF failure? Should I try again with donor eggs? What if I have IVF donor egg failure or a history of repeated IVF failure? How many cycles are enough? Are there any additional tests I can take? How to get pregnant after IVF failure? Can natural pregnancy after IVF failure happen?

These are the questions that many fertility patients ask – find out the answers in the webinar. Watch the recording above for the presentation of dr Ioannis Koutoulakis, a Consultant Gynecologist at fertility clinic Serum IVF in Athens, Greece. Dr Koutoulakis has experience with working with patients after IVF failure and is able to recommend other solutions.

Questions & Answers – IVF failure and solutions

I have had five own egg IVFs, all failed, and three natural pregnancies which all ended in miscarriage. I have had many of the tests you mentioned at Serum including two hysteroscopies and a SIS in the UK. I have also tested positive for natural killer cells. What advice would you give?

As I explained before, three things have to be optimum and in your case, after these 5 unsuccessful own egg IVF treatment and natural pregnancies, we have to investigate the egg quality first. One of the important factors in your case is the sperm and I recommend you have a denaturation sperm test. I think this is what we have to exclude.

Should my husband forgo diabetes medication and blood pressure medicine before submitting a sperm sample? Can either affect the quality? His sperm tests have always been very good.

If he forgoes his diabetes and blood pressure medication for a short period, for one or two days before submitting a sperm sample, it does not affect the results at all. But, of course, diabetes affects the sperm quality.

Six IVFs, seven transfers good quality blasts, hatching blasts and then no pregnancy. I have had so many tests due to thyroid problems. What do you advise? I never had implantation.

Thyroid problems can affect the implantation and we aim to stabilize the thyroid function at first. Then we have to investigate the endometrial cavity, an important factor for achieving implantation and pregnancy. Another thing you have to investigate is sperm quality because with good quality blastocysts there may be a hidden sperm issue affecting implantation. I recommend DNA fragmentation and investigating bacteria and period bleeding test.

I have had three IVF treatments using ICSI using husband’s sperm with very little fertilization with one egg each time except for the third treatment which resulted in no fertilization. We then went for another IVF using ICSI using donor sperm but none fertilized, saying egg issue. Now looking at donor eggs. I also have a thyroid problem. I never had implantation in any case.

In this case, the most important factor is the egg quality because if we don’t have fertilization on day one, we recommend using donor eggs to see the difference.

I’m currently taking antibiotics advised by Serum. What supplements should my husband and be taking? I was advised to take DHEA.

For your husband, it’s good to start taking antioxidant vitamins like vitamin C and vitamin E.  Regarding DHEA, we have some worries that there is a risk of cystic formation, as we have seen in a lot of cases.

Can stress during the two-week wait impact implantation? Can some foods positively help implantation?

Of course, stress can affect the outcomes of implantation and a healthy lifestyle can give us better results. But, as discussed before, don’t expect miracles from supplements and diet.

What to do after IVF failure?

5 failed on own egg cycles and two failed donor egg cycles. I’m already using immune treatment and have had implantation cuts now. Anything you can suggest?

You may try a further donor egg treatment after the hysteroscopy and implantation cuts, and if this has a negative outcome, we recommend donor sperm treatment, this means donor embryo treatment. The most important factor is the uterine cavity that you have already done. A new donor egg treatment is recommended and after this, if we still have the same unsuccessful outcome, we strongly recommend using donor sperm next time.

What do you think of LIT therapy? Is there any other alternative?

For who are not familiar with the term LIT therapy, this is a gold standard therapy for couples with recurrent miscarriages, and, after a doing a DQA match test, we check compatibility issues for the male and female. If we see they have a partial match of pathogens, then we recommend specific immunization – LIT therapy. We strongly recommend this for couples with partial incompatibility.

Do you recommend egg donor adoption?

We recommend embryo adoption treatment for couples who have tried donor egg treatment more than two or three times and whose uterine investigation comes back problems free. In these cases, we recommend donor egg and donor sperm treatment – embryo adoption treatment – which has a high success rate.

Would you suggest using donor sperm or using 50/50 donor/husband sperm to get better results?

We recommend 50/50 donor sperm/husband sperm treatment for couples who have tried donor egg treatment with husband and with an optimal uterine cavity where the result comes back negative. In such a case, we would go ahead with donor embryo treatment. For diagnostic reasons, we divide the donor eggs, half with the husband sperm and half with donor sperm, to check the difference in the embryos’ progress. We recommend this treatment in cases where we suspect some hidden sperm issues.

Do you recommend exercise before embryo transfer with donor eggs?

We recommend exercise to relieve stress, relaxation and a good healthy diet every time for a successful outcome.

Is your clinic, Serum IVF, closed the whole month of August?

We are closed from the 27th of July to the 26th of August.

What’s your view on having sex after the embryo transfer?

My view is that patients should try to avoid sexual intercourse after the transfer until the test day; two weeks after a day-3 transfer or after two weeks after a blastocyst transfer.

I had two failed IVFs with my own eggs and donor sperm and they failed with no implantation. What do you recommend I am 38 years old and AFC was around 12.

In order to achieve pregnancy, we need 3 things. The first is the egg. At the age of 38, this is still in a promising age group and we would expect about a 25% to 30% chance of a positive outcome. We need to find the best appropriate protocol, depending on scan results and AFC. The second thing is the sperm. Using donor sperm, we expect that the quality to be optimal. The third thing is the cavity. It’s good to investigate the cavity and exclude bacterial infection and, depending on the results, to investigate with an ultrasound or hysteroscopy, if needed. This means we can adjust the protocol, depending on the age, on the hormone status and the Antral follicle count – and 12 it’s very good number for this age group. Another thing is a full investigation of the cavity.

I have had two fresh IVF and two frozen embryo transfers. Do you think donor eggs treatment is the best option for me?

I would need more details about this case, of course. Donor eggs is not the only treatment, but it is the most promising option. However, all this is related to the quality of the sperm and the uterine cavity. If the uterus and the sperm are good, another thing we can do is to adjust the IVF stimulation protocol, and try one or two more times, depending on the age group. If the patient’s age is no more than 40, the most promising option is to use donor eggs.

Like many patients, I get very stressed during the whole IVF process. What would your clinic suggest to reduce stress? My previous consultant suggested reflexology? Would this be suitable prior to treatment?

In our clinic, if the person suffers from stress during the IVF protocols, we recommend acupuncture, which seems to improve the outcomes in those with high stress. Besides acupuncture, and we recommend just enjoying life: having hobbies, visiting the islands, enjoying the sunsets. Try to enjoy the rest of life and don’t overthink the IVF treatment.

For donor egg IVF, how do you compare with other clinics in Greece in terms of successful pregnancies?

I don’t like to compare our success rates with other clinics. Our success rate using donor eggs and good quality donor sperm is around 50% to 60% with an optimal cavity, using donor or good quality sperm.

What is your success rate for 40 to 42-year-olds in your clinic for donor egg/sperm? Where can I find these results?

It is the same, about 50 to 60%. In combination with hysteroscopy, this goes up to 60 or 65% using donor eggs in all age groups.

Donor egg 4AA grade 5-day blastocyst transferred, but no implantation. Never got pregnant. Did a blood-clotting test with normal results. What tests shall I do before the next FET transfer?

This very good as we have already have the embryos and you cannot change the donors or egg quality. It’s good to focus on the uterine cavity and request tests in order to investigate bacterial infection. It is also good to arrange an aqua scan or hysteroscopy for a full investigation of the uterine cavity. If the bacterial infection comes back positive, you can have immune tests like Chicago test in order to investigate the NK cells and about the immunological panel to design an appropriate treatment before starting the preparation protocols for the lining. If there are any suspicions of endometriosis, we would start pretreatment for two weeks with anti-inflammatory medications and some steroids in order to suppress the chronic inflammation which goes with endometriosis.  As the clotting test came back normal, we don’t need to recommend a blood thinner. Of course, a blood thinner is not needed but is sometimes used during the protocol and because it increases the blood supply to the lining and protects against clots in those over 40 years old on high doses of estrogen as part of the protocol.

What is the stem cell treatment you can offer? I’m 42 and have had one pregnancy after 9 failed cycles. I’ve just tried for a sibling and had another failed cycle. The feedback is that my eggs are poor quality due to my age. Would this stem cell treatment help me with an own eggs cycle?

Autologous stem cell treatment using stem cells from the period blood is an innovative and promising treatment but is still experimental. We have seen some good outcomes in many female patients, but we have to wait to have more results in the future. Egg donation is, in this case, the most promising option at the moment.

Does weight matter with donor eggs success?

Of course, weight is an important factor for the outcome, but we don’t recommend our patients lose a lot of weight before IVF treatment. It’s good to change habits like diet or to start exercising, but we don’t recommend losing excess weight because it can have side effects; it’s a too quick change to the body and it does not help the mind as it gets stressed.

Can gluten intolerance affect the results of IVF?

Gluten intolerance can affect the outcome of IVF. As we know, glucose intolerance or insulin resistance affects egg quality, as well as implantation.  In this case, for patients with gluten intolerance or with insulin resistance we recommend a low glucose index diet and Metformin for at least two to six months before starting the treatment in order to balance the glucose and insulin levels in the body.

I only have two 4AA blastocysts left. I’m 42 years old. For the next frozen embryo transfer, shall I do a single or double transfer? We have had sperm tests and fragmentation tests which have been good.

We recommend a double transfer as we don’t expect all the eggs to be optimal and we would want better chances. Of course, it would be great to investigate the cavity before arranging the next frozen transfer just to be sure everything is optimal. We would want to focus on the cavity, on microscopic findings, like bacteria, and focus on egg quality and the ovarian reserve.

If uterine problems were diagnosed, how long would it take to go on to treatment once they have been treated?

It depends on the problem. If it’s just adhesions or scar tissue, it’s good to leave it one month for a rest and to let the uterus recover and then go ahead with the next period after the hysteroscopy. If the problem is more severe, like a uterine septum or fibroids, it’s good to leave it one to three months before starting the new treatment.

I’m about to start my first donor egg cycle. I had a hysteroscopy in February with implantation cuts. Will the cuts still last?

The cuts will last at least six to eight months, sometimes a year. If it is more than a year, is good to arrange an aqua scan with an expert in order to replace the cuts, or do another hysteroscopy. If we saw from the first hysteroscopy that there was a lot of scar tissue or a septum, it’s good to investigate this again with a second hysteroscopy or an aqua scan just to reconfirm the uterine condition

With regards to my earlier question about two fresh and two frozen transfers: I’m 37 with an AMH of 10.11 and a normal sperm sample. Also, my CRP is 18.

The age of 37 is a promising age with very good outcomes in this age group. I think this case we should focus on the uterus and the sperm.

Does the blood type matter if it is different from my donor?

No, it does not affect the outcome at all. There is no blood in the egg.

I have a question about embryo adoption. Do you recommend it? I do not mean embryo donation.

Embryo donation is the same as embryo adoption and is recommended for patients with poor egg quality and problems with the sperm, but there is a difference between frozen embryo adoption and fresh donation treatment. In frozen adoption we used two excellent quality frozen blastocysts, where with fresh donor eggs/donor sperm treatment we use fresh double donation blastocysts and maybe have more embryos for freezing, depending on the number eggs we retrieve from the donor. Plus, with the quality of the donor sperm and egg, sometimes you have four or five blastocysts from the donor egg/donor sperm treatment instead of, in the case of embryo adoption, only two frozen excellent quality blastocysts.

Can repeated hysteroscopy cause scar tissue?

Hysteroscopy cannot cause scar tissue: hysteroscopy is to fix scar tissue. We do just superficial injuries in the lining and we don’t interrupt the base lining, which can cause scar tissue. The most common cause of scar tissue is bacterial infection, which can kill the normal lining cells, leading to cell death and lot of dead cells can produce this scarring. With hysteroscopy, we remove all the scar tissue and rebuild a healthy lining.

I’ve read on the Internet that children born from IVF treatment may have difficult health issues, especially when they get older. Is this true?

I’ve met children with some problem cases but there is no evidence about this and there are only just a few cases.

IVF failure – what next?

What is the cause of implantation failure in IVF? What are the signs of IVF implantation failure? Serum IVF, the fertility clinic where dr Ioannis is a Consultant Gynecologist, has been treating patients since 1989 so the clinic’s doctors have gathered a wealth of experience on IVF with own eggs and implantation issues. Fertility experts at Serum IVF believe that egg donation can be the solution which maximizes the patients’ chance of having a baby regardless of their age.

If you have had a minimum one IVF cycle failure, had multiple IVF failure or you are just preparing for your first hormonal stimulation, this webinar is for you. You can also read more on how to deal with emotional rollercoaster during IVF cycle.

About an author:

Dr Ioannis Koutoulakis is a Consultant Gynecologist at fertility clinic Serum IVF in Athens, Greece.
Serum IVF has been treating infertile female and male patients and guiding them during their infertility struggle since 1989. Serum IVF experts believe egg/sperm donation and IVF are the solutions that can maximize the patients’ chances of getting pregnant regardless of their age or egg/sperm quality.

Serum IVF offers oocyte donation of the highest standards of donor welfare. The patients are able to choose a donor who is the closest match to their phenotype. We know how important that is for many of them.



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