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Successful IVF treatment after failed attempts

Irina Kotsiubska, MD
Fertility specialist

Category:
Failed IVF Cycles

How to have a successful IVF after failed attempts
From this video you will find out:
  • How many cycles are enough?
  • Should I try again with my own eggs or only with donor eggs?
  • Can I improve my oocyte quality?
  • Are there any additional tests that I can do?
  • What can we do in the case of the male factor?
  • When is it recommended trying the tandem cycle and how it works?

From IVF failure to IVF success

Watch the webinar with Dr Irina Kotsiubska, an obstetrician-gynaecologist, and fertility specialist in Assisted Reproductive Technologies at Parens, Ukraine, and find out how to have a successful IVF treatment after failed attempts. 

There are several frequently asked questions after failed attempts that patients ask, and these include:

  • How to proceed after an unsuccessful IVF attempt?
  • What might be recommended by the specialist?
  • What Is the most realistic and most effective way to go on?
  • What was the character of the previous attempt?

It is important to have in mind that the process is going to be vastly different for a couple who has spontaneous natural conception attempts than a couple who has been through some conservative treatment, including:

  • Ovulation support
  • Luteal phase support
  • Intrauterine insemination

What is more, it is also going to be different for a couple who has been through an IVF cycle with stimulation of the ovaries and especially challenging for a couple who has been through a cycle with donated gametes unsuccessfully. Any future steps and treatment plans should be based on the following aspects:

  • Patient history
  • Age
  • Previous pregnancies and surgeries
  • Other diagnoses and medications
  • Test results
  • Previous treatments

Male factor

In the case of the male factor, there are several techniques available that can increase the chances of success. These include:

  • Sperm selection methods such as ICSI (Intracytoplasmic sperm injection) – a single sperm is injected into the cytoplasm of an egg.
  • PICS (Physiological intracytoplasmic sperm injection) – selection of the best possible sperm for fertilization before injection into the egg in the IVF protocol.

Egg donation

In case none other treatments work, treatment with donated oocytes is recommended as well as sperm donation in the most severe cases, surrogacy might be also considered.

As Dr Kotsiubska mentioned, Parens Clinic does have its own egg donor bank, that way the donors are thoroughly screened, and the quality can be controlled.

To become an egg donor, any woman must meet the following criteria:

  • young women must be a maximum of 30
  • have her own healthy biological child
  • have no bad habits
  • be both physically and psychologically healthy
  • have no hereditary diseases

Tandem IVF cycle

In Ukraine, they also can suggest a different type of treatment, not available in all countries, which is called tandem cycle. What is a tandem cycle?  Tandem IVF Cycle, is a fertility treatment where both the expectant mother’s eggs and donor’s eggs are used to create embryos for implantation. Both normal IVF treatment and egg donation IVF treatment are performed together. What are the indications for a Tandem cycle?

  • several unsuccessful IVF attempts with own eggs and sperm
  • low number of good-quality embryos after the embryo transfer
  • low number of eggs after the retrieval, low AMH level
  • age over 40
  • poor sperm quality
  • cases in which TESE (Testicular sperm extraction) is required

PGT- A (Preimplantation Genetic Testing for Aneuploidy)

If patients are experiencing unsuccessful IVF treatment options, another option that can be suggested is genetic testing called PGT-A (Preimplantation Genetic Testing for Aneuploidy). A few cells are removed from an embryo to help select the best embryo(s) to avoid a genetic disease for which a couple is at risk.

 

- Questions and Answers

I started a double donation program with another clinic. I received 5 embryos. Is this a good number? I have 3 BA, 3 BB, which I will transfer in a week’s time, and I froze 3 embryos 4BB. I was expecting to get a lot of A quality embryos. Is this normal to not receive AA? Also, my new clinic doesn’t freeze any Cs. I know that Parens used to transfer Cs. Why is this so different in the clinic’s attitudes? All my C-embryos were not frozen now, and I’m a bit concerned.

You received 5 good quality embryos. In our clinics, we very often use embryos of AA, but during our practice, sometimes, it’s better to receive the embryos of 4BB because remember that an embryo of 5AA is very hard to get, and not all can give us the implantation. Sometimes when we see a good quality embryo, the genetic analysis might not be good even if we have 5AA embryos. About, CC embryos, those are of very low quality, and very rarely they can give us pregnancy. It’s better to do a transfer with embryo 3 or 4 BB or 5 BB or BA, such embryos, can give us a pregnancy.

I’m 38, and I have endometriosis, which is not severe. I’ve had many failed PGS tested transfers. Could my endometriosis be the cause? What would be the next step? Should I consider surrogacy?

It depends on the stage of your endometriosis. If it isn’t too severe, there is no difficulty in your uterus, it shouldn’t be a big problem for receiving a pregnancy. First of all, I would like to ask you if you ever did a hysteroscopy, and if everything was okay during hysteroscopy, you can try again to do a transfer. If everything is okay with your endometrium, I don’t think that endometriosis will be a big problem because, in our practice, a lot of patients with this disease receive their own pregnancy after an IVF program. It depends on a hysteroscopy picture, and I would like to see your hysteroscopy results if you’ve ever done this.

I’m 47 years old with a failed FET with blastocyst. I had 8 eggs, and being told by day 3, before the transfer, there were 5 embryos. On the day of transfer, while I was at the clinic, there was only 1 left. I was assured it was the lucky one. I appreciate that European clinics are good but coming from London, I felt I was just a number and that no care or concern was given having spent so much money.

In your case, I would advise you to do another donor program. It might be better to take another donor. Maybe you have had some problems with sperm analysis of your husband because if you use a donor, you would have received more good embryos, 2 or 3 embryos. In general, when we receive eight eggs, we receive a good blastocyst by 40%. In this case, I would like to see a sperm analysis of your husband.

Which prenatal vitamins are the best that contain folate (not folic acid) in Ukraine?

When it comes to supplements, we always prescribe folic acid and vitamin E, Omega-3, and vitamin D. When it comes to other vitamins, it would be better to take it one month or three months before pregnancy, a lot of various vitamins are available, and you can find them in different countries. We don’t prescribe folate, we prescribe folic acid.

How to prevent the uterus from cramping after transfer? Valium? Nospa?

I prefer nospa or papaverine, but it depends on the week. If we speak only after a transfer, it will be better to use only Magne B6, it will be enough, and when we have some problems after a transfer, in this case, we’ve just got another medication like Nospa, or some other ones.

What is your opinion regarding the use of EmbryoGlue?

We also use EmbryoGlue, and in my opinion, it is very good. We use this culture for the patients who are over 35 when we receive few embryos or few oocytes, and if you’ve had unsuccessful IVF treatment before.

Do you do mitochondrial transfers or Pro Nuclear and Spindle Transfer?

No, we don’t perform such transfers at our clinic.

I have had repeated implantation failure of 6 good quality blastocysts. I am just 33, although the husband has a very low sperm count. Is there anything I can do about the failures, or are there any tests to explore?

If it’s only a problem with a low sperm count, we can propose a tandem program, using your husband’s sperm and from donor sperm. We could also suggest doing a PGT analysis of your blastocyst using sperm from your husband. If you have a good quality blastocyst, a genetic test might still be good because you might see a good quality blastocyst, but still, you might be receiving not a very good genetic analysis. We can propose a genetic analysis or using a tandem program.

What are the actions you offer post-implantation? Example: Do you monitor progesterone levels and adjust medication accordingly? How do you proceed with patients from abroad?

If we speak about the IVF cycle, during stimulation, we monitor progesterone levels and estradiol levels. We need to decide if we do transfer in the same cycle or if we need to do transfer in the next menstrual cycle. When we do the transfer, in the next menstrual cycle, sometimes we prescribe progesterone, if it’s necessary, it all depends on each patient’s history, and we start it during the preparation of the endometrium or after embryo transfer. If we think that you can have a low progesterone level after embryo transfer. When it comes to patients from abroad before the program, during the program, we always speak with our patients, either by mail, messenger, WhatsApp, and we give them our recommendation or prescription during the whole program and during pregnancy.

Do you recommend steroids to patients who have multiple sclerosis to aid implantation?

Yes, sometimes, I recommend steroids to patients who have multiple sclerosis to help the implantation, but it depends on the patient. There are many other medications that we prescribe in this case.
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Authors
Irina Kotsiubska, MD

Irina Kotsiubska, MD

Dr Irina Kotsiubska, is an obstetrician-gynaecologist, fertility specialist in Assisted Reproductive Technologies at Parens, Ukraine.
Event Moderator
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.