Eight things to make IVF fail
3/21/2016 03:21:00 AM
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
What can we do to the eight things?
Poor response
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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.
|
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.
|
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