Why are my Fertility Treatments ending up in failed cycles?

Fertility treatments which are not successful can take a toll on the couple, both emotionally and financially. However, the one benefit is that lessons can be learned from each failed cycle which will help in strengthening the reason for the next one to be a success!

There are various forms of ART (artificial reproductive treatment) technologies, the most common of which are the following:

Fertility drugs – if there is an ovulation problem, drugs like Clomiphene pills and Gonadotropin injections regulate hormones and help release egg/s. The pregnancy rate for this is about 25 – 40%.
A warning about these drugs/injections is that they can cause unpleasant side effects, like allergic reactions, headaches, fever, joint pains, etc. These medications should only be taken on the advice of medical practitioner or Infertility specialist.

Laparoscopy – a keyhole surgery to unblock the fallopian tubes or remove scarring caused by cysts, fibroids or endometriosis. The success depends on the circumstances of the individual. An after effect of this is belly soreness for a few days.

IUI (Intrauterine insemination) – The female partner is stimulated by hormone therapy to produce more eggs during a particular cycle and the best quality sperm from the partner/donor is injected into the uterus. The pregnancy rate is about 8 – 20% in women aged under 40 years. A side effect is probable cramping for a day or so.

IVF (In vitro fertilization) – After hormonal stimulation of the female partner, the eggs are removed from the ovaries (oocyte retrieval), fertilized with the sperm in a petri dish in the lab and left to grow into embryos while being periodically monitored. Then the embryos are implanted in the womb. The success rate is 40% pregnancy rate and 33% live birth rate for women under 35 years, using their own fresh eggs. There may be unpleasant side effects and raised chances of a multiple pregnancy.

ICSI (Intracytoplasmic sperm injection) – the embryo, resulting from a single sperm injected into a single egg is transplanted into the womb. The success rate is about 43%, slightly higher than the IVF.

DI (Donor insemination) – sperm from a donor is used by IUI, IVF or ICSI technique to fertilize the egg. The success rate is about 14% live birth rate (without fertility drugs) and 31% for IVF using fresh eggs and donor sperm for women under 35 years.

Embryo donation – another woman donates an egg which is mixed with sperm and implanted in the womb. Rate of success is 32% live birth rate using fresh embryos from donor eggs and partner sperm and 30% live birth rate using fresh or frozen donated embryos in women of all ages.
These success rates can vary and are mentioned just to give an overall idea. Also success rates in women above 35 years are usually lower. Studies have shown that the more number of cycles of ART, the higher the success rates.

The reasons for ART failures are multiple and can refer to various situations, such as

• Insufficient follicles are produced, so the IVF cycle is cancelled, prior to egg retrieval.
• The quality of the embryo – sometimes, there are flaws which result in the embryo not implanting.
• No quality eggs are retrieved – the age of the eggs plays an important part in this and, if the eggs are retrieved from a younger donor, the more chance of fertility, even if the woman is older!
• The retrieved eggs do not fertilize or the fertilization is inadequate – sometimes, a woman’s ovaries do not respond strongly enough to fertility medications to produce multiple eggs, especially if the woman is over 37 or has high FSH (follicle stimulating hormone) levels. Hence, no embryo may be available for transfer to the uterus.
• Transferred embryos may not implant for a variety of reasons (some of which are that the egg or the sperm have abnormal chromosomes) which will result in no pregnancy.
• Lifestyle factors: 2 of the major issues are smoking and obesity. If smoking is cut and weight is lost, there is more chance of fertility treatments being successful.
• Idiopathic factors: sometimes, all conditions are optimal, however, the ART cycle can end up in failure with no known cause.

Currently, before an ART cycle, or in some cases to help counteract the failures of previous fertility treatments, some diagnostic tests are recommended. The female and male partner undergo a battery of lab tests and other investigations to determine possible causes for infertility. From the male perspective, routine blood tests and a basic semen analysis are normally prescribed. While the routine semen analysis test is very helpful as an initial screening tool, it has its limitations in that it reports only on the external characteristics of the sperm/semen sample and cannot give any indication on the DNA quality of the sperm which has been shown to play a vital role in the success of an ART treatment cycle and a successful pregnancy. A Sperm DNA Fragmentation test or Sperm DFI test (DNA fragmentation index) is essential to evaluate the integrity of sperm chromatin or abnormal genetic material within the sperm which, in turn, can give more information about the DNA quality of the sperm and help the clinician choose the most appropriate mode of future treatments or in some cases provide answers to previous failed fertility treatments.
Hence, do not feel too despondent if your fertility treatments have not yet met with success. If you have not yet had a Sperm DFI test done, this could help answer unanswered questions. We at Andrology Center, offer the only standardised, best Sperm DFI test – the SCSA® Test. You can contact us at +91 9443793934 or email info@andrologycenter.in for more information on the SCSA® Test.