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Eight things to make IVF fail

What are the causes of IVF failure? Young patients usually get their IVF babies after 1~2 cycles. In the patients over 38 years or with low ovarian reserve, multiple IVF cycles are always necessary. Eight things are common in the patients over 38 years or AMH < 2 ng/ml.

Eight things to make IVF fail
Poor response
The follicles cannot be stimulated by external rFSH. It may result in the follicle atresia or growth arrest.

Premature ovulation
Ovulation in IVF generally occurs 36-40 hours after the triggering. Premature ovulation during IVF results in the cancellation of oocyte retrieval.

Empty follicle
Mostly one follicle contains one oocyte. It is found that there is no oocyte in a follicle after the retrieval.

Low oocyte yield
Only mature oocyte (MII) can be fertilized. Nearly 70% of the retrieval oocytes can be used for the following fertilization in the patients under 35 years; in those over 40 years, the yield is dropped down to 50% or even lower.

Low fertilization rate
The general fertilization rate (2PN) in IVF is around 70%, but it can be lower or complete fertilization failure.

Abnormal fertilization
Two pronuclear zygote (2PN) is observed after a normal fertilization. An abnormal fertilization happens while three pronuclei (3PN) or mutiple pronuclei are observed.

Developmental arrest
Around 95% of 2PN zygotes grow into the cleavage stage. Developmental arrest could happen at any time point during embryo mitosis, e.g. one-cell arrest, 2-4 cells arrest, 6-8 cells arrest, arrest at compaction stage...etc.

Low blastocyst formation rate
After five days of culturing, an embryo undergoes cell proliferation and differentiation to become a blastocyst. No blastocyst formed or no blastocyst with good morphology formed at the end of culturing happened in IVF sometimes.


What can we do to the eight things?
Poor response
Individualizing stimulation protocol by adjusting with maternal age is a method, such as mild stimulation, natural cycle, or multiple retrievals in a IVF cycle.

Premature ovulation
Individualizing the time of triggering and retrieval by adjusting with maternal age, follicle size, and total follicle count. Non-steroid anti-inflammatory drugs (NSAIDs), which was reported to prevent premature ovulation in the previous data, can be applied 8~14 hours before the retrieval as well. For an example, the trigger shot may be injected while the follicle reaches to 17 mm in diameter to the patients under 40 years, but it may be injected while the follicle reaches to 15~17 mm in diameter to those over 40 years to prevent the premature ovulation.

Empty follicle
It cannot be avoid if the empty follicle forms naturally.

Low oocyte yield
The patient can undergo multiple IVF cycles to harvest available oocytes (oocyte accumulation).

Low fertilization rate
The quality of sperm and oocyte could be the reasons. The ICSI/IMSI can be applied to select the sperm with better morphology. Of the quality of oocyte, it cannot be solved due to the effect of maternal age.

Abnormal fertilization
If it resulted in abnormal fertilization (3PN or multiple PNs) while the ICSI/IMSI had been applied, the quality of oocyte could be the main reason. Oocyte accumulation by multiple IVFs is the only solution.

Developmental arrest and Low blastocyst formation rate
Similarly, developmental arrest or no available blastocyst formed during culturing occurs spontaneously and cannot be avoid. Embryo accumulation by multiple IVFs is the only solution.

Stork Fertility Center Stork Fertility Center Author

Overseas IVF: the best gift after visiting Taiwan twice

Baby's Feet on Brown Wicker Basket
Although my parents-in-law did not push us to have babies, I knew that they were eager to have grand children. When the baby really came to my family, I felt that our home became more complete.

When I see my adorable baby, I can't stop appreciating the anonymous donor and Stork Fertility Center. My mother-in-low told me that she is refreshing and energetic every day. My father-in-low said that he feels released from his chronic disease and joyful. These happened after the baby came to my house.

At first of my marriage, my parents-in-law did not push us to have babies, but I just knew that they were so eager to have the grand children. That's why my family have been changed so much after the baby came. In the very beginning, I was not that eager to be a mother, and I did not want to be a dinky in the rest of my life either. As time went by, I found that my friends became parents gradually, and I was still occupied by piles of work. I started to join several mother-to-be forums and hoped that it would be my turn soon. However, my baby did not show up. It might be caused by my terrible life style, which was filled by tight works and lack of exercises. I noticed that pregnancy was difficult, so I started trying some herbal medicines. Luckily, I was pregnant after trying for a few months. Since the beta-HCG value seemed so good, I stopped taking the herbal medicines and the related monitoring. I thought that it was all right.

The worst thing occurred after the first trimester. When I went back to the hospital, my doctor told me that the embryo had stopped growing. It was such a shock!

I began googling and trying again, but the things did not work. After I did the genetic exam, the report said that my chromosomes existed balanced translocation, which was a common cause to recurrent miscarriage. The related websites said that IVF plus PGS/PGD may help the success rate, but the technique was not prevalent at my locality.

At first, I underwent several IVF/PGS programs at some nearby cities, but the results were disappointed. I clearly knew that I must find another solution. Nothing could stop me to be a mother. I prepared to do it overseas, and applied for a new work position, which was more flexible, and exercised three times a week. 

After doing some online works, I choose the Stork Fertility Center. The doctors there suggested me doing the IVF/PGS again. Considering about my schedule and budget, I finally decided to take the oocyte donation program, which was more efficient at my age. Like the other recipients, I was bothered by the relatives' attitudes, the future appearance of child and the other trivial concerns.

I asked myself," which is more important, the appearance or the health of my child?" 

If the baby's blood was not from me, wouldn't we love him/her that much? Absolutely no. He or she would be in my womb, and exchange everything with me. After he/she was born, he or she would accompany with us in so many years. Compared to the desire of having a child, these problems seemed so negligible.

I finally made up my mind, and entered the program. The decision was so right.

During the program, I only came to Taiwan two times, one for the paper works, and one for the frozen embryo transfer. The embryo was just stably implanted in my womb after the first cryotransfer. Until the baby came out of my body, every one said that he looked like me so much.

The journey of having babies was not easy every moment, but I almost could not remember that period when I am with my baby. When the miracle really came to my home, all the pain was just in the hazy memory.

arms, baby, birth
Per two patients with egg-donated program in Taiwan, there would be one from the Stork Fertility Center. 

Stork Fertility Center Stork Fertility Center Author