Failed IVF with own eggs. Causes and what you can do differently on your next attempt

Bogna Sobkiewicz, MD
Gynecologist & Obstetrician
Małgorzata Wójt
Head of Embryology Lab

Failed IVF Cycles

Failed IVF with own eggs. Causes and what you can do differently on the next attempt?
From this video you will find out:
  • What are the causes of failure when conceiving with own eggs?
  • Does the quality of embryo transfer impact the result?
  • How can the male factor cause be eliminated?
  • What uterus examinations are carried out at Salve Medica?
  • When immunological tests are required?


Why IVF with own eggs fails and what can be done to prevent it?

Watch the webinar with Dr Bogna Sobkiewicz, Gynaecologist & Obstetrician, and Małgorzata Wójt, MSc, Head of Embryology Lab at Salve Medica, Poland.

To understand why IVF treatment fails, it is important to understand the causes of failure to conceive with own eggs

IVF failure – causes

The main factors mentioned include gametes, embryo transfer, and uterus immunology which are involved in the whole process although causes of failure to conceive with own eggs is an aspect that is usually overlooked.

Quality and quantity of eggs

On the part of women, we have to list the following.

  • The quality of egg cells depends on
  • Woman’s age
  • AMH
  • Endometriosis

The number of egg cells depend on:

  • Age
  • AMH
  • State after ovary surgeries

State of the uterus

Other causes are known to be related to the state of the uterus such as:

  • Polyps
  • Myomas
  • Uterine abnormalities
  • Adhesions

State of endometrium

  • Uterine submucous myomas
  • Quality of endometrium after uterine curettage
  • Inflammatory conditions
  • Number of natural (NK) cells in the endometrium
  • Endometrial receptivity

Quality transfer

Also, transfer quality is an important factor because it can be changed depending on the individual. The performance involves the following:

  • Presence of scar after Caesarean section
  • Very significant anteflexion of the uterus
  • Very significant retroflection of the uterus, especially if combined with scar after Caesarean section
  • performance of scratching in the proceeding cycle to check the possibility of access to the uterine cavity
  • transfer quality resulting from ultrasound imaging quality-excessive obesity or unfilled urinary bladder

When it comes to men, it’s crucial to look at the quantity and quality of semen. It is known that a lack of performance of additional semen tests could point to other semen deficiencies, some of which could be counteracted with the use of adequate in vitro technologies.

Genetic abnormalities

Another factor that can cause IVF failure is genetic abnormalities in women or men transmitted to embryos. In some cases, from one part of the partner, there are genetic loads such as incorrect karyotype, although it is not common. Most of these errors arise during the cell division of the gametes and embryos hence efficiency of IVF decreases.

Immunological causes

It is said to be a field in progress, yet some aspects are taken into account

In man: The test of MAR (mixed antiglobulin reaction) is performed; high MAR values can be an issue

In women, in case of intercurrent immunological diseases:

  • Lack of inhibiting antibodies – low values of MLR (monocyte/lymphocyte ratio) test
  • Abnormal relations in antibodies: NK/ CD4 / CD8, TNF

When the caueses are clear, it’s important to eliminate them, starting with the ones that are the simplest, but also the most easily accessible options.

IVF Failure – investigation

According to Dr Sobkiewicz, at Salve Medica Clinic, they usually start with extend semen tests before proceeding with IVF procedure.

Extended semen tests include:

  • Swim-up, which is a sperm purification method, which effectively segregates highly motile sperm into the upper fraction while retaining sperm with low or no motility in the lower fraction.
  • HBA (the hyaluronan binding assay), which evaluates the maturity of sperm in a fresh semen sample
  • DFI (DNA fragmentation index), checks the genetic material (DNA) of the sperm, detecting potential sperm damage.
  • MAR (Mixed Antiglobulin Reaction) is a method for the detection of auto-antibodies attached to spermatozoa in fresh semen
  • Semen culture and PCR tests infectious agents

It allows us to employ adequate techniques that increase the success rate of the IVF procedure already in the first cycle.

Another important aspect is detailed analysis of the state of a woman’s uterus, which is necessary and it implies:

  • Ultrasound scan
  • Hysteroscopy
  • Uterine cavity cultures
  • Endometrium test aimed at evaluating the number of natural killer (NK) cells
  • Magnetic resonance imaging

Analysis of conducted transfers helps to improve the outcomes, and that includes:

  • Evaluation of experience of specialists conducting embryo transfer
  • Performing quarterly analysis of the success rate of transfers conducted by each team member
  • The presence of blood outside and inside the catheter
  • Own evaluation of transfer done by the person conducting the transfer

In the case of less experienced team members or members with decreased effectiveness, the most experienced doctor supervises conducted transfer to eliminate possible errors.

At Salve Medica Clinic, scratching is routinely performed. To avoid problems in the embryo transfer cycle, or by additionally performing hysteroscopy in the cycle preceding embryo transfer. In female patients from couples whose embryos are of good quality but in whose case correctly conducted transfers do not only yield the anticipated result, but we will also perform a detailed immunological test.

  • CBA test allows for the assessment of the balance between Th1 and Th2 cytokines
  • IMK (immunophenotype test) helps determine if immunological factors are the cause of failures.
  • MLR (Mixed Lymphocyte Reaction Test), helps to evaluate the presence of blocking antibodies
  • KIR in women and HLA-C in man test is a genetic test that allows to assess the risks of the embryo being rejected by the maternal immune system

For Patients with abnormal results of the mentioned test,  the following procedures in cooperation with immunologists are performed:

  • Immunizations with partner lymphocytes that decrease the percentage of embryos rejected by the woman’s organism
  •  Immunological treatment
  •  Intralipid is administered

In cases where excessive uterine activity is expected, drugs that decrease uterine contractions are prescribed during embryo transfer. It’s also important to perform an endometrial receptivity assay (ERA test) and do the transfer accordingly. When AMH values are low, or semen parameters, simulation results, or embryo culture results are unsatisfactory, we consider discussing with the couple the validity of the following procedures:

  • Egg donation
  • Using donor sperm
  • Adoption of embryos

According to the results presented at Salve Medica, these are the numbers:

  • Fresh donor eggs- 58%
  • Frozen donor eggs – 56%
  • Average number of embryos transferred per embryo transfer – 1.1 (higher number of embryos result in higher risk of multiple pregnancy)
  • Preferred embryo transfer is day- 5 (blastocyst)
- Questions and Answers

What is the average number of IVF with own eggs attempts before success?

It is a very difficult question because it depends on many factors. The younger women have completely different success rates than older patients. We look at the age of the couple, we look at the quality of the embryos, we look at different things. In Poland only three attempts with own eggs are refunded by the state. We also look at the will of the couple, if they want to try once again with own eggs. We always inform them that sometimes the success rate is very low. But if the couple would like to try again and again with their own gametes, we also do it but we always tell them that the success rate is low.

Before my next IVF attempt (one failure) I did hysteroscopy and the conclusion of the biopsy was signs suggesting chronic type of endometriosis and some evidence that could support the presence of a benign hyperplastic lesion such as an endometrial polyp or endometrial hyperplasia. What we concluded with my doctor was to proceed with egg retrieval and fertilization with sperm donor (due to low AMH 1.07 ng/ml and my age 38), do the appropriate treatment (antibiotic injections into the endometrium and antibiotic pills) and then do hysteroscopy again before proceeding to embryo transfer. Do you agree with this approach?

Yes, of course. However, you have to know that endometriosis may cause some problems and it’s a little bit more difficult to treat endometriosis, especially the adenomyosis. You have to know that it can be a little bit more problematic for you. I agree that it’s important to start with egg retrieval and then cope with the endometrium problem.

After endometrial scratching when should you proceed with embryo transfer? If you do scratching and proceed with embryo transfer six months later, will scratching have the same effect compared to situation when the transfer is performed one month later?

We use endometrial scratching for two reasons. The first reason is to check if the cervix is not blocked. This way we can avoid potential problems with inserting the catheter into the uterine cavity. During the transfer, the catheter contains delicate embryos and we want the transfer to be as gentle as possible. The second reason, according to the research, is connected to the fact that after scratching in the consecutive cycle, the cytokine profile in the uterine cavity changes. This, to a small extent, has an impact on the transfer success. But only on the condition that scratching was done in a previous cycle.

I’m 45 and have NK cells. I’ve had two failed attempts (IVF and ICSI). I’m now considering egg donation. Would you recommend doing this and would the NK cells prevent it from working? Do you have to have extra treatment for the NK cells before proceeding? Is there anything I can do or take to help suppress these cells?

We are not the immunologist so we’re not a good persons to ask these questions. There’s also a little bit difference between the natural killer cells in the endometrium or in the blood. It also depends on which natural killer cells we are talking. We all have natural killer cells and, for example, in the endometrium. It is important whether their level is high or low. It’s not enough information for us and as I said at the beginning we are not the immunologists.

Do uterine contractions have major impact on the success of embryo transfer? My previous transfer was quite painful as I have a tilted cervix and they struggled to get the catheter in. What would you suggest to help with transfer? My clinic does not believe in doing a uterine scratch.

Scratching solves two problems. One of them, is the scratch and another is that it allows us to go through the cervix. Sometimes we do the hysteroscopy. When we have the problem to do the scratching with a special catheter to the uterus, we perform hysteroscopy and to find a way where it goes. Sometimes it’s going more to the left, sometimes it’s going more to the right. When we do the hysteroscopy, we can find out how it goes and it allows us to go with the catheter this way. The contractions – when we perform the embryo transfer, we try not to touch the fondues, to do it as smoothly as we can, we use a very delicate catheter because we do not want to have the contractions. We do not want to cause any pain to our patients because we believe that it can diminish the probability of success. We sometimes have to struggle as well. Sometimes we have the problem with the transfer and, even though, we always try to make it a smooth as possible, you should remember that this is medicine and sometimes it’s difficult or even impossible to know something beforehand.

I’ve had fibroids and laparoscopy. I’ve had five failed IVFs. What is the best way to proceed?

It is difficult to say because we have so many different types of fibroids (myoma). It depends on where they were localized, if they touch or go to the uterine cavity. If the myomas were out of the uterus, they are less important for us, unless they are not very big. But it is also important if during the if the cavity was of the uterus was open or not, if there are any scars on the uterus. There are so many different problems that are important to know. Even though that sometimes we know that there are fibroids or the myomas but there’s another problem as well like low quality of semen, eggs or the embryo. So even if we know that there is a problem with myoma, there can be still another problem that is just difficult to diagnose.

I have low AMH. Are there any supplements you recommend to help improve the egg quality? I’m 35 and I’ve read that in a book “It starts with the egg.”

The egg quality – it is difficult sometimes. We know that when you use DHEA 2-3 months before the egg retrieval, it can help a little bit. There are some studies that say that the growth hormone can be a good solution but it’s difficult to use, it’s very expensive, there is no refund in Europe for the growth hormone and it’s a little bit still experimental to use it. Sometimes it is good to use the testosterone but, even though, sometimes when we try to help our patient and we use these solutions, even though the egg quality is slow because of the age or low AMH, it is difficult to help them. Also, it depends on the age of patients because sometimes low AMH in younger patients is better than older patients. The genetics is like that – we are aging and our gametes as well.

Does DHEA only help with egg quality due to low egg reserve? Can you also take it if you have a higher than average MH. I’ve heard it helps with recurrent miscarriages as well.

I haven’t heard that it helps with recurrent miscarriages I ‘m not sure if it makes sense to take it with the higher than average AMH. We try not to ask our patients to take everything what they can. Patients look for solutions but sometimes they can they do some things that have no studies, are experimental therapies so we do not recommend this.
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Bogna Sobkiewicz, MD

Bogna Sobkiewicz, MD

Bogna Sobkiewicz, MD, graduated from the medical department at the Medical University of Łódź, Poland, in 2013. Today she is finishing the specialization in gynecology and obstetrics. However, she has been interested in the issues of infertility since the beginning of her medical education. At the university, she joined the European Society of Human Reproduction and Embryology (ESHRE) and started to attend the annual meetings. She is also a member of ASRI (The American Society for Reproductive Immunology), PTG (the Polish Society for Reproductive Medicine), PTMRiE (Polish Society of Reproductive Medicine and Embryology), ESGE (European Society for Gynecological Endoscopy). Her attention is focused on endoscopy, small procedures and counselling. In her free time, she broadens her knowledge about diets, she goes on bicycle trips (if the Polish weather permits), but generally, she uses her holidays to visit the far ends of the world. She speaks Polish, English, German, and basic French.
Małgorzata Wójt

Małgorzata Wójt

Małgorzata Wójt is the Head of Embryological Laboratory and Senior Clinical Embryologist at Salve Medica, a clinic specialised in assisted reproduction procedures. Within 18 years of experience in the field of fertility, she has completed a series of trainings and workshops in Poland and in the world. Certified Senior Clinical Embryologist by ESHRE. Privately, the mother of a teenage daughter, who likes good literature and traveling.
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Caroline Kulczycka

Caroline Kulczycka

Caroline Kulczycka is managing MyIVFAnswers.com and has been hosting IVFWEBINARS dedicated to patients struggling with infertility since 2020. She's highly motivated and believes that educating patients so that they can make informed decisions is essential in their IVF journey. In the past, she has been working as an International Patient Coordinator, where she was helping and directing patients on their right path. She also worked in the tourism industry, and dealt with international customers on a daily basis, including working abroad. In her free time, you’ll find her travelling, biking, learning new things, or spending time outdoors.