Why does IVF with donor eggs fail sometimes? How many failed IVF attempts should be worrying? What is the solution for implantation problems and repeated miscarriage? You can watch the video recording from the webinar above to learn more about these questions.
If you have had at least one failed IVF with donor eggs
or you are preparing for your first egg donation programme, this webinar is exactly for you. Find out what to expect, what factors affect the programme’s success or failure and what to look out for during preparations for your next egg donation cycle.
Embryo quality vs implantation problems
Patients deciding to use donor eggs typically do so after IVF with their own oocytes has repeatedly failed. It can, therefore, come as a saddening realisation to discover that IVF with donated oocytes is not always the magical hoped-for cure. Whilst the use of donor eggs is indeed associated with increased pregnancy rates, like any other fertility treatment it can unfortunately also fail.
In this webinar, Dr Maria Arque, a specialist in obstetrics, gynaecology and reproductive medicine at Fertty International Clinic, Barcelona
, discusses the most common reasons for unsuccessful IVF when using donated oocytes.
There are three main recognised causes behind unsuccessful donor egg IVF treatments; the embryo, the endometrium and the blood flow and immunology.
30% of eggs retrieved have the potential to result in aneuploid
Good quality gametes (egg and sperm) must be used in order to create a healthy, viable embryo and for those using a donor, the quality of oocytes will presumably be high. However, whilst clinics rigorously test all donors, around 30% of eggs retrieved still have the potential to result in aneuploid (abnormal number of chromosomes) embryos. This can be due to differing factors such as the regimen used for ovarian stimulation and also clinic specific lab processes. When looking at data and recently published papers around donor egg treatments, there is a suggestion that euploidy rates, in donor egg cycles, significantly differ between fertility clinics. On average, a 70% euploid (healthy chromosomally complete) embryo rate would be expected from donor egg IVF.
Male factor can also affect embryonic health and various testing, including karyotypes and DNA fragmentation, is always recommended.
Whilst a good calibre embryo is key for a positive outcome following any IVF treatment, it is important to understand that it is not the only determinant. In order to implant, a healthy embryo also needs a favourable environment. Anatomical uterine factors such as fibroids, polyps, adhesions or other malformations can affect embryo implantation. Clinics should fully screen the recipient’s uterine cavity, to look for any endometrial issues, in advance of any donor egg IVF treatments.
If an egg is fertilised and implants during a natural cycle, the newly pregnant body enters the luteal phase. During this stage of pregnancy, the corpus luteum naturally produces the correct amount of progesterone required to support pregnancy development. All of which needs to be closely replicated when undergoing assisted conception; transferring the embryo during the correct window of endometrial receptivity is imperative. Clinics should ensure the recipient’s endometrium and hormonal levels are ready to accept the embryo. Progesterone is usually prescribed, and recipients are monitored in advance of the transfer.
Another cause, which can affect implantation is the thickness of the endometrium wall.
Endometriosis can lead to a thinning of the linin
Conditions such as endometriosis can lead to a thinning of the lining, or refractory endometrium, as can radiotherapy treatment for cancer. Clinics generally believe an endometrial lining measuring circa 7mm is optimal for an embryo transfer, although some studies have found similar results when transferring with uterine lining
of 5mm; every patient and every embryo is different.
Blood flow and immunology might currently be considered as controversial subjects but are believed to have a negative impact on implantation. Conditions such as thrombophilia (an abnormal tendency to develop blood clots) and / or Natural Killer Cells may affect the recipient.
Dr Arque explains that although it is known a healthy immune system and good blood flow to the endometrium are essential for implantation, the current medical understanding surrounding these issues remains incomplete. She advises that immune testing and empirical treatments must be approached with caution until further data is gathered, and more definitive conclusions can be made.
The importance of a healthy lifestyle
Finally, Dr Arque stresses the importance of a healthy lifestyle; even though the eggs are being collected from a donor, the overall health and lifestyle habits of the recipient are just as crucial. Even before the embryo is transferred recipients should fully prepare themselves, abstaining from smoking and excessive exercise, drinking only in moderation and ensuring they are neither over or underweight, all factors known to have a negative effect on embryo implantation
Whilst the use of donor eggs can truly help many women achieve their dream of experiencing pregnancy and carrying a child to term, they are not infallible.
Donor egg IVF treatment can fail, even with a top-grade embryo. For a pregnancy to become established implantation must also happen, and for that a healthy endometrium and immune system is necessary.
It is important to remember that every person is unique, it is, therefore, the duty of clinics to provide a tailormade service for each individual. The window of endometrial receptivity is not necessarily the same for all patients and preparing the hormones and uterine cavity won’t always be achieved by using standardised protocols. A thoroughly personalised embryo transfer, completely in sync with the recipient’s body, is what clinics should strive for and is what will ultimately help achieve the only outcome wanted from donor egg IVF.
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