When an IVF cycle fails, the first question patients ask is – Why did it fail ?
When we have transferred a top quality blastocyst , but it fails to implant, the truthful answer often is – we don’t know .
The next question is – What are you going to do differently the next time ?
In a good clinic, the options are fairly limited, when we use the same eggs , the same sperm and the same uterus in the next cycle.
Now, since the sperm and the uterus themselves have a very limited role to play, the focus has to be on improving egg quality .
In order to improve egg quality , we can advise the patient to make certain lifestyle changes , and put the patient on supplements such as vitamin D and DHEA, with the hope that this will help.
Many patients will try a Mediterranean diet , or use antioxidants and acupuncture to try to improve egg quality , but no one is really sure whether this helps or not .
On a more practical basis , the one thing which the doctor can do is change the regimen used to grow eggs . We can use a different superovulation protocol , and there are 3 options we can explore.
We can use a different protocol . There are various options available, such as a short down regulation protocol ; a long down regulation protocol ; or an antagonistic protocol . Each of these has pros and cons, and it’s well worth trying an alternative to see if another protocol will give better results . A good doctor will explain your options, and tell you what he is using for you, and why.
We can change the dose of gonadotropin injections used for superovulation . Sometimes this helps , but you can never be sure , and there is no simple correlation between the dose of gonadotropin used and the quantity or the quality of the eggs retrieved. In fact , paradoxically , using minimum stimulation actually helps to improve egg quality because while we get fewer eggs , the eggs may be more mature . and we may end up getting better embryos.
Finally , it is extremely important for you to understand that gonadotrophins come in various brands , and you should insist that your doctor use a high quality brand and when superovulating you. Often, the reason for poor quality eggs is the fact that the doctor did not use a high quality gonadotropin for your superovulation . This is a surprisingly common problem , and many doctors cut corners and use cheap urinary gonadotropin products , where the quality control is not very good , as a result of which patients don’t respond very well to the superovulation . This is why the only drug we use for superovulation in our clinic is Gonal-F which contains pure recombinant FSH and gives us consistent results . This way, if the patient doesn’t respond well to the superovulation , we know that the problem is not with the drugs, but with her ovarian biological response.
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