After long-term treatment for infertility, the couple decides on IVF. And it seems that the long-awaited pregnancy is so close that some women even begin to look after baby things, a stroller, toys in advance. However, the first in vitro fertilization protocol often does not bring the desired result. Why this happens and what is the probability of success, we will tell in this article.
Reasons for failure
To begin with, it should be noted that no doctor, no clinic, either in Russia or abroad, can guarantee a 100% pregnancy. With this thought, one should go to the first IVF, it will help to survive the failure easier and move on towards the goal.
Only 45-50% of couples manage to get pregnant the first time. This means that by entering the first protocol, the chances of getting pregnant are almost 50x50. Then everything depends on the health of the man and woman, on their age, on how high-quality their eggs and sperm are, as well as on other reasons. The first IVF is almost always associated with a high load on the woman's body - she first undergoes an ovarian stimulation procedure, as a result of which doctors are able to obtain a larger number of mature eggs for in vitro fertilization.
Hormone therapy is rather aggressive, which cannot but affect the woman's health.
The main reasons why the first IVF is unsuccessful are as follows.
- Woman's age. The older the patient, the lower the chances of successful IVF on the first attempt.
- Hormonal disorders The high level of follicle-stimulating hormones, which are used to obtain superovulation in the first phase of the menstrual cycle, creates not the most favorable background for bearing a baby. If ovarian hyperstimulation syndrome occurs with their increase, then the chances of pregnancy are considered rather low.
- A small number of eggs. The fewer oocytes of normal quality obtained as a result of puncture, the less likely pregnancy is. This is not uncommon in natural cycle IVF, when hormonal stimulation is not previously applied. Then doctors can receive only 1, maximum 2 eggs.
- A small number of embryos. Even if a sufficient number of eggs are received, it is not a fact that all of them will successfully pass the fertilization stage. Embryos that begin to develop from fertilized oocytes are carefully monitored and selected - only high-quality, viable and strong ones are chosen for implantation into the uterus. If there is only one such embryo, the probability of successful completion of the protocol will be significantly lower.
- Endometriosis in a woman. If the endometrium is not uniform, its thickness is insufficient, implantation may not occur. Even hormonal support for endometrial growth, carried out in the first phase of the cycle, is not always successful.
- History of abortion and surgery. If earlier a woman had to have abortions, as well as undergo diagnostic or therapeutic curettage, the endometrium partially loses its functions. Postoperative changes in the endometrium are also difficult to correct.
- Genetic incompatibility of partners. To exclude such a reason for unsuccessful IVF, you should visit the genetics in advance and do tests for the compatibility of partners. Now, genetic research is mandatory for couples who have IVF only if the woman and man are over 35 years old. Others can do this analysis of their own free will.
- Chronic and acute ailments. In the process of stimulating superovulation under the influence of high doses of hormones, chronic diseases in a woman, for example, pathologies of the kidneys, liver, heart, diabetes, can be aggravated. After embryo transfer, a woman could get a viral infection or catch a cold, in which case the likelihood of successful IVF also decreases.
- Poor semen quality. If IVF is carried out using donor material, such a reason is completely excluded, because donor sperm undergoes strict medical control, and with spermogram disorders a man simply cannot become a donor. When fertilizing eggs with the husband's sperm, there can be certain difficulties if there is a male factor of infertility.
- Hydrosalpinx. Sometimes it is not possible to detect the accumulation of fluid in the fallopian tubes during a medical examination before IVF - this pathology is not always noticeable even on ultrasound. However, hydrosalpinxes prevent the development of pregnancy. Some doctors are inclined to believe that about a third of unsuccessful first IVF attempts are associated with the tubal factor, however, some experts are of the opinion that hydrosalpinx cannot harm the implantation process. Check with your doctor for his opinion.
The first IVF is often unsuccessful for reasons that even highly qualified doctors cannot explain. These are the so-called idiopathic causes. All analyzes were normal, the embryos were of good quality, the transfer was successful, the endometrium was ready, but for some reason the implantation did not take place. Such an outcome is not the rarest and it is recommended to treat it as a process that is simply beyond the control of a person, because in the process of conception and implantation, far from everything is under the control of doctors.
Reduces the likelihood of success after the first attempt, overweight in a woman, her wrong attitude to her health. So, non-compliance with the recommendations to lead a calm measured lifestyle after replanting, limit physical activity, sleep at night quite often leads to a lack of a positive result.
Smoking or drinking even small amounts of alcohol after embryo transfer halves the success rate. The stress that a woman feels since the beginning of the IVF protocol and which accumulates every day can also hinder the implantation of embryos, and if it is successful, it increases the likelihood of an early miscarriage.
The reasons why it was not possible to achieve positive results in the first protocol may lie in the immune and autoimmune processes, as a result of which pregnancy at the cellular level is rejected by the woman's body.
The likelihood of success in numbers and facts
The first ultrasound protocol, like the notorious pancake, may well be "lumpy". Only half of women under the age of 35 manage to become mothers after the first IVF. If a woman is already 37-39 years old at the time of IVF, then the probability of pregnancy in the absence of obvious reasons for failure in a woman is about 35%.
At the age of 40, only 15-19% of women after the first IVF become pregnant. At 42-44, this probability is below 8%. And even at this age, the likelihood of becoming pregnant in the IVF protocol is generally higher than with natural conception.
In a couple of reproductive age, healthy and without problems with the reproductive system, with intercourse directly on the day of ovulation, the chances of conceiving the first time are only 7-10%.
The first unsuccessful IVF attempt is not a verdict and not a reason for despair, if only because about 25% of couples who failed in the first IVF protocol, after a while, self-conception is obtained, since the reproductive system after hormonal stimulation from the outside begins to work more efficiently ...
In the second and third protocols, the probability of getting pregnant is higher than in the first, by about 5-10%. However, after an unsuccessful fourth or fifth IVF attempt, the chances of success decrease and are no more than 15%.
In 60% of cases, when two or more embryos are transplanted, multiple pregnancy occurs after IVF, and a woman who dreamed of one child gives birth to twins or even triplets.
When to try again?
Only a doctor can answer this question. The most favorable time for the next IVF attempt depends on the health status of the spouses, on the identified reasons for the failure in the first protocol. That is why one should not despair, but rather act.
Usually, on average, a woman is given about three months to recover. If the first IVF was performed without hormonal stimulation in the natural cycle, you can plan a new protocol as early as the next month after your period ends.
If the first protocol was stimulated, then, with a high degree of probability, eggs or embryos may remain that meet all the requirements of reproductive specialists and embryologists, but were not useful the first time. Then, after three months, the woman can be prescribed a cryoprotocol. She will no longer undergo a "shock" hormonal attack and puncture of the ovaries; in a favorable period, she will simply transfer cryoembryos, previously thawed. In this case, there will be no hormonal therapy, ovarian puncture, the woman will be less susceptible to the harmful effects of medications and stress, respectively, the probability of success will significantly increase.
Useful Tips
It is quite difficult to significantly increase the chances of IVF success in any way. But ignoring the recommendations that the doctor gives before the first IVF or during the recovery period before the second (third and other) attempt can nullify the efforts of doctors. Therefore, a woman who is determined to become a mother should remember the following.
- It is imperative to pass all the recommended tests on time. This will help you figure out the reason for the first failure. The doctor, based on the test results, will more effectively adjust the following protocol.
- The depression and anxiety experienced by women who have gone through failed protocols should be a thing of the past. In a dysfunctional psychological and emotional state, it is better not to plan a new attempt, since stress disrupts the natural hormonal background and prevents pregnancy. It is advisable to visit a psychotherapist. This specialist can help you deal with frustration after the first failed attempt and effectively prepare for the next.
- Recovery is an important process. This means that between attempts a woman needs to rest as much as possible, go in for sports, swim, and lead an active lifestyle. With the permission of the doctor, it is worth trying physiotherapy, hirudotherapy, mud baths, massage, including gynecological. Do not forget about the positive emotions that sex gives, especially since after the unsuccessful first IVF, the sex life of the spouses throughout the entire recovery period is not regulated by medical recommendations. Do not forget that sometimes it is during the recovery period that a couple can get pregnant on their own, if initially the cause of infertility was not the tubal factor and not the absence of ovaries.
- Take a keen interest in everything that is written in your medical record. If the doctor has established that the reason for the unsuccessful first attempt was poor-quality embryos, this is the first sign that you need to change the clinic and the doctor as soon as possible, because a good embryologist will never recommend embryos with developmental disabilities for transfer. If it was revealed that the embryos were injured during the transfer, the advice is the same: change the clinic.
- Enlist the support of family and friends, husband, friends. Do not withdraw into yourself, do not be left alone with your anxieties and experiences. This will help maintain good spirits and optimism. And they can still come in handy.
And in conclusion, some more useful statistics: the most often long-awaited pregnancy in a woman occurs on the second attempt - 45% of successful IVF cases. In 25% of cases, pregnancy occurs after the third protocol. But there are also women who manage to get pregnant only after 8-9 IVF protocols.
For this reason alone, one should not despair. Modern reproductive technologies allow women to find the joy of motherhood at the age of 25, 50 and even older. Even the most difficult diagnoses that have led to infertility can be defeated if the woman is positive.
In the next video, the hosts of the program "Life is great!" will debunk the myths that have formed around the "test tube babies" and will tell about the features of this procedure.
