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Fig 8. The Programmable embryo freezer. You can see the liquid nitrogen vapors clearly.
While we still cannot freeze unfertilized human oocytes efficiently, a new technique called vitrification (which uses ultra-rapid cooling together with an increased concentration of cryoprotectants) may allow us to offer this option to our patients, in the future, allowing the facility of egg storage and egg banking.
If you don't get pregnant after your IVF attempt, you are likely to be very disappointed and disheartened. However, remember that this is not the end of the road - it's just the beginning! At the end of the IVF cycle, you need to sit down with your doctor and analyze what you learnt from it. Was the ovarian response good? Was the endometrium receptive? Did fertilization occur? Why didn't pregnancy occur (though this is usually a question we still cannot answer!)? Can you repeat the same treatment, or do you need to make changes before going in for your next attempt? When can you go in for your next IVF cycle? And even if you do not get pregnant, at least the fact that you attempted IVF should give you peace of mind that you tried your best, using the latest technology medical science has to offer.
Most doctors would advise you to wait for a month before starting a new cycle. While it is medically possible to do the next cycle immediately, most patients need a break to marshal their emotional strength before starting again. Your doctor may need to modify your treatment, depending upon an assessment of your previous cycle. For example, if the ovarian response was poor, the doctor may advise you to increase the dose of drugs used for superovulation.
If fertilization did not occur, you may need to go in for microinjection (ICSI). If the quality of the embryos was poor, you may be advised to consider a ZIFT rather than IVF. When an IVF cycle fails, many patients want to do "something new" or "something different" in the next cycle. However, do remember that the commonest reason for a failed IVF cycle is the failure of the embryos to implant - and since this is still an area of profound ignorance, there is little we can do to increase the probability of successful implantation occurring the next time. Rather than look upon the cycle as a "failure", it's better to treat it as having provided valuable information - for example, evidence that the sperm can fertilize the egg, which proves that they are normal! For patients who have had an embryo transfer, the odds are stacked in their favor that they will get pregnant sooner or later. Nevertheless, there is a lot of pressure to try the "newest or latest advance" the next time - which is why many clinics now offer expensive techniques such as immunologic testing and even immunotherapy - but these are still in the realm of "scientific witchcraft" and have not been proven to be helpful. In fact, if the IVF cycle was satisfactory, the doctor will often advise you to repeat exactly the same treatment again - and all that it may take to achieve your IVF success is time and another attempt.
When an IVF cycles fails, there is a lot of pressure on both patient and doctor. Many patients will change the doctor because they do not conceive - but this is not usually a good idea, unless you are unhappy with your medical care. Doing a second IVF cycle in the same clinic is usually better than changing doctors, because your doctor can now tailor his treatment based on his observations during your earlier treatment cycle. Interestingly, we often find that couples going through a second IVF cycle are much more relaxed and in control. This may be because they are aware of all the medical and procedural minutiae, and are better prepared for these; and also because they have had a chance to establish a personal relationship with the medical team. Also, since they have already faced failure the first time around, many of them are much better able to cope with the stress of IVF, since they are prepared for the worst. With today's IVF technology, we can confidently reassure any patient that we can help them to get pregnant, provided they have inexhaustible resources of time, money and energy!
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
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