DEALING WITH IVF FAILURE

Couples who undergo IVF treatment usually have very high expectations. There is a subconscious reluctance to admit that they might very well be among the unsuccessfully treated patients although it is still clear that failure is more likely than success.

IVF is an expensive and stressful experience which increases our expectations of the process. Expectations of success are considerably higher than the success rates quoted at their initial consultation.

The endpoint of IVF treatment, which is the transfer of two or sometimes three embryos into the uterus, is not the same as a pregnancy. There is a waiting period of about two weeks after the embryo transfer before it can be determined whether the woman has achieved pregnancy. This further increases the frustration of the process.

A success rate of 25-30% means that the failure rate is 75-85%. No one likes to think about failure when embarking on a new venture. There are very few medical programmes where emotions are so highly charged and where the failure rate consistently exceeds the success rate.

Treatment can fail at any stage: ovarian stimulation, egg collection, fertilization, cleavage and implantation. All that IVF demands of the person – financial, emotional, fear coupled with courage and determination potentates failure.

Any woman who decides to make the financial outlay for IVF and subject herself to the inconvenience of injecting herself everyday for up to three or four weeks expects to get pregnant from the process and the disappointment of failure becomes much more acute.

Two of the most traumatic points of failure are failure in fertilization and the return of the menses, which results from a failure in implantation. There is a feeling of isolation, confusion and helplessness and you ask, “what went wrong?”

Sometimes, one never really knows why it has failed despite the ‘good’ prognosis (relatively young age, normal uterus, high quality embryos transferred) but it is helpful to discuss with the doctor and embryologist who saw the embryos and can give an assessment. The unexplained situation is always the most difficult to bear. Failure is often easier to bear when we can pinpoint a reason for that failure.

A review of the treatment cycle by looking at the ways in which a couple responded to the drug stimulation: number of eggs collected, semen issues, fertilization and the grading of the embryos, etc., may give some clues as to how to adjust a repeat treatment.

After experiencing a failure, there is often considerable merit in delaying the decision to undergo a repeat cycle treatment.

If you have had more than one failed IVF, consider changing clinics, especially if your doctor doesn’t have a change in protocol planned.
Remember that all cycles are not alike. Using the exact same protocol on another attempt even at the same clinic can lead to different results. (Rachel Browne)

References:
‘The Bridge Clinic’s ‘Fertility Update’ September 2005 Vol No 3
‘Birthright,’ August 2005

IMMUNE SYSTEM AND IVF FAILURE

IMMUNE TREATMENT ‘CUTS IVF FAILURES’

Suppressing the immune systems of women who suffer recurrent miscarriage may be able to allow many more to give birth.
The technique may also help those who suffer repeated IVF failures, or who cannot get pregnant, without an obvious reason why.

A leading US expert is presenting the results of his first, small scale study into a therapy at a UK conference on Monday, and these suggest it could be a highly successful approach - even among older patients.

Many thousands of women have unexplained infertility, suffer recurrent miscarriages, or cannot succeed with IVF, despite their young age and apparently good health.
Professor Alan Beer from Chicago Medical School, says that, in some cases, the problem may be an immune system which turns on the newly-implanted embryo and destroys it.

Although the father's genetic material is present in the embryo and on the surface of the placenta, the mother's body does not reject it.

However, in some cases, there is strong evidence that this process goes wrong.

Test and treat
He believes he has developed both a test for those women who are at risk - and a potential treatment to counter the problem.

Professor Beer concentrated on women who have suffered recurrent IVF failures, in which implanted fertilised embryos do not produce a successful pregnancy.

He found that seven out of ten women with three IVF failures had higher than normal levels of a chemical called tumour necrosis factor alpha (TNF alpha).

This is a product of a type of immune system cell called a natural killer cell, and is responsible for damage to tissues in "autoimmune" diseases such as lupus, rheumatoid arthritis and Crohn's disease.

Professor Beer's theory is that the immune system is also attacking the embryo in women with recurrent miscarriage, saying that the body was treating the embryo "like a cancer".

Existing drugs
There are existing medications used to reduce levels of TNF alpha in the body - but these are currently only licensed to treat established auto-immune disorders.

In trials involving 100 patient who had all suffered repeated IVF failures, he found that 78% of those under 35 years old managed to become pregnant.

Even a significant proportion of those aged 40 and above managed to get pregnant this way.

The treatment has so far produced 80 live births.
Professor Beer said: "It's like when you find the correct area code and you connect the telephone call - these healthily infertile women proved to me that their bodies were made to have babies.
"The breakthrough was to find what component of the immune system was doing the killing - and then reduce that component to normal levels."

'Astonishing'
Dr Simon Thornton, from Nottingham's Care in the Park clinic, said: "A third of our patients have an unexplained infertility.
"Professor Beer suggests that an abnormally active immune system is blocking pregnancy or acting to stop it from developing.
He has shown astonishing success rates in patients who would have otherwise had very very low success rates.
"At present, we use IVF as a treatment for many patients who have unexplained infertility - but this may be a much more straightforward treatment to allow them to have a perfectly successful pregnancy."

Dr Mohammed Taranissi, from the Assisted Reproduction and Gynaecology Centre, told the BBC that the results, although small-scale, were "impressive".
He said: "It's something we have suspected for a long time.
"Now we have to see whether we can apply a drug which has been developed for another problem for infertility problems."

SOURCE: BBC NEWS