Six years into their marriage, Neeraj and Ankita were trying to get pregnant for almost 3 years. After several unsuccessful attempts, the couple was diagnosed with male factor infertility and finally decided to undergo IVF treatment. The couple still failed to conceive, and after 5 failed IVF attempts in a span of 18 months, Neeraj and Ankita were advised to undergo MACS for better results. Today, Shreya is in her 5^th month of a healthy pregnancy.

Infertility is a growing concern around the world. India has nearly 10-12% of married couples who suffer from the inability to conceive naturally. Among them, only 1% of couples have turned to IVF (in – vitro fertilization) or other infertility treatments for pregnancy. However the uptake of Assisted Reproductive Technology (ART) for conceiving is on the rise. In the 40 years since the world’s first IVF baby was born, over 8 million IVF babies have been born worldwide.

Dr. Parul Katiyar, Fertility Consultant at Nova IVI Fertility, Delhi said “IVF is usually opted by couples who even after trying for several years are unable to conceive naturally. Often fertility treatments are recommended to patients having blocked or damaged fallopian tubes, male factor infertility, which also includes decreased sperm count or sperm motility, women with ovulation disorders or who have had their fallopian tubes removed, premature ovarian failure, uterine fibroids, unexplained infertility, etc. The treatment modalities for two patients are never the same, as each patient faces a different fertility issue. One patient may conceive undergoing a simpler treatment like medication or IUI (intrauterine insemination), while other may require multiple cycles of IVF or ICSI (intracytoplasmic sperm injection). Thus, it is very important to understand the reason of infertility for better treatment.”

Reasons for IVF failure

Determining the cause of IVF failure or understanding the possible causes of failure like age, quality of eggs or sperm, the health of uterus, etc. helps in planning the treatment in a way that tackles the problem effectively and allows for better chances of success. Here are the known reasons why an IVF cycle can fail.

Fertilisation failure

The quality of the eggs plays a major role in the success of an IVF cycle. The quality and quantity of woman’s eggs deteriorate with age. The ovarian reserve of a woman also tends to decline sharply after the mid-30s. Women with a reduced number of viable eggs or elevated FSH levels might not respond properly to IVF medications, thereby reducing the chances of a successful IVF cycle.

Likewise, the quality of the sperms is equally important for IVF. Health, motility, and quantity of a sperm determine its efficiency in fertilising an egg. There are even cases of DNA fragmentation in sperms that cause genetics or chromosomal abnormalities in an embryo which in turn causes fertilisation failure.

Implantation failure

The reasons for implantation failure could be because of uterine health and/or quality of the embryo. If the endometrium (lining of the uterus) is not thick enough for the embryo to be attached or if it does not provide the necessary nutrients for the embryo to develop in the first few days, the embryo fails to implant to the uterine wall. Conditions like fibroids, endometrial polyps, congenital anomalies, intrauterine adhesions, and hydrosalpinges can cause a weak endometrium. The health of the embryo depends on the quality of the gametes; if embryos were formed using sperms with DNA fragmentation or in cases with advanced maternal age, there may be an implantation failure.

The lifestyle of a patient also plays an important role in the outcome of an IVF cycle. A nutritious diet, maintaining healthy body weight, and reduction or elimination of alcohol and smoking helps in a successful IVF cycle. Women who are overweight or underweight not only have an increased risk of infertility but also have fewer chances of a successful IVF cycle versus women of normal weight.

Advanced technologies that improve success rate of IVF

“With the increasing trend in personalised medicine and healthcare services, IVF has witnessed a growing need for individualised protocols such as personalised embryo transfer (pET) and individualised ovarian stimulation to optimise treatment. ART has developed with multiple solutions to aid in finding a suitable treatment alternative for every infertile couple. Technologies like blastocyst culture, Magnetic Activated Cell Sorting (MACS) and reproductive genetics like Preimplantation Genetic Screening (PGS), Preimplantation Genetic Diagnosis (PGD), and Endometrial Receptivity Array (ERA) have helped to increase the success rate of IVF by significant percentages,” said Dr. Parul.

Embryos are transferred to the uterus within 2 or 3 days of insemination in a conventional IVF treatment cycle. When an embryo is allowed to grow until day 5 in the lab, it is known as blastocyst culture. Unlike the conventional IVF method, blastocyst culture and single blastocyst embryo transfer reduce the risk of multiple pregnancies and IVF failure in patients.

Genetics also contribute up to 10 per cent of recurrent pregnancy losses in couples. Embryos with an incorrect number of chromosomes fail to implant or miscarry during the first trimester of pregnancy. PGS allows screening for chromosomal abnormalities in embryos during an IVF cycle. All 22 types of chromosomes are analyzed using PGS in order to detect aneuploidies (alterations in the number of chromosomes), which are the leading cause of miscarriages and recurrent implantation failure.