Examinations after unsuccessful IVF. What to do after an unsuccessful attempt

To begin with, I really sympathize with the girls who have gone through unsuccessful protocols and in order to help them overcome these failures, I will try to systematize the procedures and tests that need to be carried out for the next successful and pregnant IVF.
Aware means armed, so as not to tear your hair out of despair, but when you come to the doctor with a list of questions, you need to know what to do next.

So: If you don't get pregnant after your first IVF attempt, of course you will be very upset and disappointed. However, remember that this is not the end of the journey - this is just the beginning! After an unsuccessful IVF cycle, you will meet with your doctor and analyze what conclusions can be drawn.

When analyzing an unsuccessful IVF attempt, the doctor pays special attention to the quality of the embryos and endometrium, as well as other important points:

1. Was your body optimally prepared for pregnancy? Of course, the fact of the presence of certain common and gynecological diseases does not always affect the onset of pregnancy, but on the other hand, a decrease in the ability to conceive in many diseases cannot be ruled out. Therefore, it is necessary to prepare the body for conception and conduct IVF during a period outside of the exacerbation of any chronic diseases.
2. Was the ovarian response to stimulation good enough?
3. Has fertilization occurred?
4. Were the embryos obtained good quality, did they develop normally in laboratory conditions?
5. Was the thickness and structure of the endometrium at the time of transfer optimal?
6. Were any abnormalities in the development of the endometrium identified during the IVF program?
7. Has implantation occurred, as determined by a blood test for the hCG hormone two weeks after embryo transfer?
8. Why didn’t pregnancy occur (although there is no answer to this question!).
9. Is it necessary to carry out any additional examination before your next IVF attempt?
10. Do I need to do any treatment before my next IVF cycle?
11. Can the same treatment regimen be repeated or does it need to be modified before trying again?
12. When can I start a repeat IVF cycle?

Even if you don't get pregnant, the very fact that you went through IVF will allow you to move on with your life knowing that you did the best you could using Newest technologies that modern medicine can offer.

Possible factors of failure after IVF:

1. Autoimmune factors. In the presence of these factors, the woman’s body has increased aggressiveness towards the embryo. Immune factors are divided into cellular and humoral immunity factors:
   • Autoimmune humoral factors include increased levels of antibodies to cardiolipin and other phospholipids, β2-glycoprotein 1, native and denatured DNA, factors thyroid gland, to nerve growth factor, high numbers of B1 lymphocytes.
   • Autoimmune factors of cellular immunity include increased numbers of cytotoxic cells (killer cells): CD8, CD56, CD16. Diagnostics similar factors miscarriage is carried out special research blood - immunogram. If high numbers of killer cells are detected, an additional molecular genetic study is desirable: analysis for polymorphism of cytokine genes (cytokine profile study).
2. Alloimmune factors are conditions when the cause of miscarriage is the similarity of histocompatibility antigens in husband and wife. To diagnose such factors of miscarriage, examination is carried out for class II HLA genes (HLA-DRB1, DQA1 and DQB1 typing), as well as a mixed culture of lymphocytes. In this case, both spouses donate blood.
3. Thrombophilic factors. The tendency to more active blood clotting in women (thrombophilia) is one of important reasons recurrent miscarriage. To diagnose these factors of miscarriage, a number of studies are carried out: hemostasiogram, analysis for mutations of the hemostasis system, blood homocysteine, D-dimer, activated protein C, lupus anticoagulant.
4. Hormonal disorders.
5. Anatomical changes in the genital organs (uterine anomalies, uterine fibroids, endometrial polyps, etc.).
6. Infectious factors.
7. Chromosomal disorders. To diagnose chromosomal disorders, a study of the karyotype (chromosome set) of the spouses is carried out.

• karyotyping,
• HLA typing for a married couple,
• blood test for antiphospholipid antibodies,
• lupus anticoagulant,
• serum blocking factor,
• antibodies to hCG
• study of immune and interferon status.
• Doppler examination of the vascular bed of the genitals. The method allows you to painlessly, quickly, and informatively determine whether there is a lack of blood circulation in the uterine area, and, accordingly, oxygen starvation in embryos.

In addition, it is recommended to perform hysteroscopy and separate diagnostic curettage to assess the condition of the uterine cavity and endometrium.

Endometrial pathologies

In order for embryo implantation to be completed successfully, the size and structure of the endometrium is of great importance. In practice, it has been proven that a successful outcome during in vitro fertilization is most often observed if the size of the endometrium at the time of embryo transfer is from 7 to 14 mm. As a rule, the doctor pays attention to this first.

If there are any doubts about this, it is best to focus when preparing for the next IVF protocol on the treatment of endometrial pathologies.
Endometrial diseases:

One of the main diseases of the endometrium, chronic endometritis, is usually detected using ultrasound. A transvaginal sensor allows you to detect an increase in the uterine cavity (up to 3-7 mm), as well as the presence of fluid in it.

IN Lately There is a dependence of local immunity on the state of the endometrium. Thus, B-, NK- and T-cells, as well as macrophages, are contained in the healthy endometrium of non-pregnant women in very small quantities. Chronic endometritis provokes a powerful activation of various local inflammatory reactions. And this factor should be taken into account when choosing a method of infertility treatment.

Inflammation of the endometrium is accompanied by an increase in the number of NK cells, T lymphocytes, macrophages, an increase leukocyte infiltration endometrium, as well as a powerful increase in IgM, IgA, IgG titers. Activating, local immune reactions interfere with the normal processes of invasion, placentation, and chorion development. As doctors who care for pregnancy note, such pathologies often lead to miscarriage.

With pathologies that affect the basal layer of the endometrium, scars can form on it. Restoration of the endometrium in this case occurs very rarely, and the formation of significant synechiae often becomes the cause of infertility.

The presence of a chronic viral-bacterial infection of mixed origin in patients, for a long time proceeding without obvious symptoms, becomes the cause of activation of the immune system and hemostasis, initiating an unsuccessful outcome of IVF - the death of the embryo and its rejection. Procedure
First of all, you need to be thoroughly examined and then undergo appropriate treatment.
First, you should perform a diagnostic hysteroscopy, based on the results of which your doctor will choose treatment methods.
Hysteroscopy can detect not only endometritis, but also diseases such as polyposis, adenomyosis, the presence of an inflammatory process in the cervical canal, as well as the existence of fibroids and septa.

Very often, simultaneously with hysteroscopy, doctors prefer to take a culture test, which helps identify the causative agent of the inflammatory process. In this case, it would be most appropriate to assign antibacterial treatment. Do not forget to clarify this issue with your attending physician, who will perform a hysteroscopy, as well as an endometrial biopsy.

Patients suffering from infertility with a history of various surgical procedures, such as cleansing, abortion, childbirth, hysteroscopic examinations followed by diagnostic curettage, automatically fall into the so-called risk group. It is precisely these women who decide to undergo IVF that are often found to have hidden symptoms inflammatory process concentrated in the uterus.

Treatment methods in this case depend on many nuances, these may be:

• laser and physiotherapy;
• drug therapy (antibiotics);
• alternative medicine (homeopathy, hirudotherapy, herbal treatment);
• Spa treatment.

In some cases, another examination of the uterus should be performed to evaluate the biophysical profile of the uterus. Perhaps the reasons for the unsuccessful outcome of such a method of infertility treatment as in vitro fertilization lie precisely in this.

And lastly, dear girls, believe in yourself, believe in your lucky star!!!

*** The article does not replace a visit to your doctor and should not be considered as a medical recommendation

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The effectiveness of the in vitro fertilization procedure, according to statistics, after the first attempt does not exceed 30%. You should not expect 100% success, even if the procedure is carried out in the best foreign clinics. Unsuccessful IVF after the first attempt is not a death sentence. Several of them can be carried out. Next, we will try to understand the reasons that most often cause unsuccessful IVF.

Unsuccessful IVF: main reasons

• The main reason why IVF failures occur is the low quality of the resulting embryos. In order for the procedure to be successful, it is necessary to place into the woman’s uterine cavity those embryos that consist of 6-8 cells and also have high performance division. Poor-quality embryos can be obtained in situations where the embryologist’s qualifications are insufficient, or there are disturbances in male and female reproductive cells (eggs, sperm).
• Unsuccessful IVF can occur if there is any damage to the inner layer of the uterus (endometrium). Normally, for high-quality and successful attachment of the embryo in the uterine cavity, the presence of endometrium with a thickness of 7-14 millimeters is necessary. Most often, endometrial pathology, which is determined after unsuccessful IVF, is chronic endometritis, polyps, hyperplasia or thinning of the endometrium. All these disorders are quite easily diagnosed using ultrasound examination(ultrasound).
• Unsuccessful IVF may be a consequence of obstruction fallopian tubes patients, as well as when fluid accumulates in them. This is enough serious pathology, which requires treatment, and most often surgically.
• Genetic disorders in one or both spouses can provoke a situation where IVF is unsuccessful.
• The presence of special antibodies in a woman’s body that prevent pregnancy from occurring even through artificial insemination.
• Hormonal imbalance in a woman's body. It has been scientifically proven that the entire process of egg maturation, their release from the ovaries during ovulation, fertilization, attachment (implantation) in the uterus and subsequent pregnancy are regulated by hormones. Which means any hormonal disbalance violates the integrity of this chain and leads to IVF failures.
• Availability bad habits both spouses. Malicious influence alcohol, nicotine, narcotic substances has been proven for a long time and is not subject to any doubt.
• Age factor. How older age women undergoing IVF, the higher the risk that these IVFs will fail. The same applies to the partner whose sperm is used to fertilize the egg.
• Obesity is a problem that has serious overall impact on the woman's health status. It may be the reason that IVF is unsuccessful.
• Polycystic changes in the ovaries, leading to the fact that the quality of eggs decreases and it is much more difficult for sperm to fertilize them.
• Ovarian depletion, which occurs for some reason and leads to a decrease in follicular reserve. If a patient has such a pathology, it is very difficult to obtain high-quality eggs in the required quantity.
• Infectious diseases, such as herpes, mycoplasmosis, chlamydia, cytomegalovirus infection, Epstein-Bar infection, hepatitis B, C and others, increase the likelihood that IVF will fail.
• Adhesive processes that exist in a woman’s pelvis also lead to unsuccessful IVF attempts.
• The presence of acquired or congenital anomalies of the uterine structure in the patient (bicornuate or saddle uterus, uterine fibroids, etc.) can be a serious obstacle to pregnancy.
• Unsuccessful IVF may be a consequence of chronic somatic diseases gastrointestinal tract, of cardio-vascular system, respiratory system, as well as other organs and systems of the woman’s body.

In the case where even repeated IVF is unsuccessful, you need to more carefully look for the reason that leads to this.

Failed IVF: no periods

Each woman's body reacts differently to the in vitro fertilization program. If IVF has failed and there is no period, there is no need to panic. Most often, the restoration of the menstrual cycle occurs several months after unsuccessful IVF. The reasons for the delay of menstruation after artificial insemination are those medicinal and invasive interventions in the woman’s body that were performed to stimulate superovulation, take eggs from the ovaries and introduce embryos into the uterine cavity. You should know that under no circumstances should you take hormones and other medications on your own if IVF has failed and you are not menstruating.

In addition to the absence of menstruation, there are also often copious discharge after artificial insemination. This phenomenon does not indicate serious problems, but is a consequence of taking various hormonal drugs. Sometimes patients after unsuccessful IVF note that menstruation is longer and more painful, which occurs due to the same stimulation of superovulation that is carried out before the IVF procedure.

Most often, the next menstruation will be the same as before IVF. If the restoration of menstruation has not occurred, then it is necessary to see a specialist.

Physiological pregnancy after unsuccessful IVF

There are statistics that show that more than 20% of partners who had an unsuccessful IVF program subsequently conceived a child naturally. This is explained by the fact that the IVF protocol involves taking various medicines, which seem to trigger physiological hormonal cycle women. Thus, the natural mechanisms of the woman’s reproductive system are activated.

Repeated IVF after failure

Before repeating IVF after an unsuccessful attempt, both partners must restore their physical and psycho-emotional health. For this you need adhere to special recommendations.

• Rest and rest until the next in vitro fertilization protocol. At this time, “light” sports (swimming, exercise, dancing, yoga, etc.) will help restore the body’s strength. It is advised to pay special attention to those exercises that improve blood flow in the pelvic organs.
• Normal sex life, which should not be carried out according to a special schedule.
• Conducting additional examinations, taking tests, and performing procedures that will help identify the reasons that IVF was unsuccessful.
• Another way out of depression important factor, overcoming which, it is possible to carry out repeated IVF. After all, everyone knows that depression and stress significantly reduce the chances of success. During this period, the support of relatives, friends and significant other is extremely important. If this is not enough, then you need to seek help from a specialist (psychologist, psychotherapist).

Repeated IVF: how many attempts are allowed

According to experts, the in vitro fertilization protocol does not have any special effect negative influence on female body. The number of times repeat IVF can be performed must be determined individually and together with the attending physician. Cases have been described where successful IVF occurred only in the ninth procedure.

There is an opinion that after the third or fourth attempt, when IVF is unsuccessful, you need to think about other infertility treatment options. This may be the use of donor germ cells (eggs or sperm), ICSI fertilization or surrogacy.

At the Volgograd IVF Center clinic you can undergo a full examination and infertility treatment, including the use of IVF.

The IVF cycle includes several stages, and each of them must be successfully overcome to move to the next stage:

• growth and development of at least one follicle must begin
• follicles must mature
• shouldn't happen premature ovulation before follicle puncture
• During puncture, the eggs must be successfully retrieved from the follicles
• sperm must fertilize at least one egg
• the fertilized egg must begin to divide and develop
• the embryo must be implanted in the uterus

In this chain, implantation still remains a mystery to scientists - why doesn't every embryo become a child?

Using modern technologies, we are successfully able to obtain embryos in the laboratory, but we still cannot control the implantation process. We don't know what kind of embryo will become, and this brings a lot of disappointment to both the doctor and the patient.

Implantation is a very complex process. First of all, the embryo must continue to develop to the blastocyst stage and then emerge from its shell (zona pellucida). The hatched blastocyst must then implant into the endometrium of the uterus at short period time, called the implantation window. The three main phases of implantation are known as opposition, adhesion and invasion. Opposition, or orientation of the embryo in the uterine cavity, begins at the moment when the uterine cavity is maximally reduced due to the absorption of the fluid in it by pinopodia (small tuberculate structures that appear on the outer membrane of the cells lining the uterus).

Adhesion blastocyst is a chain of biochemical reactions leading to its attachment to the endometrium. Many molecules such as cytokines, growth factors and integrins play important role in that complex process, during which the blastocyst and the maternal endometrium enter into a subtle “dialogue”.

Invasion is a self-controlled process that allows the embryonic trophoblast (the cells of the blastocyst that will later become the cells of the placenta) to penetrate deep into the decidual maternal tissue (the cells of the endometrium that will later form the maternal part of the placenta) and invade the endometrial bloodstream. This occurs due to the development of special chemical substances called proteinase.

For successful implantation of the blastocyst, immune mechanisms are also very important, ensuring dialogue between the tissues of the mother and the embryo, which are genetically and immunologically different. Activated cells of decidual tissue and trophoblast cells produce a large number of immunologically active substances, causing the necessary immune reactions.

How implantation is regulated and occurs remains a mystery, but it is worth noting that in humans the implantation process is surprisingly low in efficiency - Nature is not always competent! An absolutely healthy married couple has only a 20-25% chance of conceiving a child each menstrual cycle. Responsibility for such low efficiency lies both with the embryo itself and with disturbances in the embryo-edometrial dialogue. Today we know that one of the main reasons for unsuccessful implantation is genetic pathologies embryo. Basic Research in the field of implantation are of great interest, since, apparently, implantation is the main factor limiting the effectiveness of ART. However, we have much more to learn before we can really control this process.

Analysis of a failed IVF cycle

If you don't get pregnant after your first IVF attempt, of course you will be very upset and disappointed. However, remember that this is not the end of the journey - it is just the beginning! After an unsuccessful IVF cycle, you will meet with your doctor and analyze what conclusions can be drawn. When analyzing an unsuccessful IVF attempt, the doctor pays Special attention quality of embryos and endometrium, as well as other important points:

1. Was your body optimally prepared for pregnancy? Of course, the presence of certain general and gynecological diseases does not always affect the onset of pregnancy, but on the other hand, a decrease in the ability to conceive in many diseases cannot be ruled out. Therefore, it is necessary to prepare the body for conception and conduct IVF during a period outside of the exacerbation of any chronic diseases.
2. Was the ovarian response to stimulation good enough?
3. Has fertilization occurred?
4. Were the resulting embryos of good quality and did they develop normally in the laboratory?
5. Was the thickness and structure of the endometrium at the time of transfer optimal?
6. Were any abnormalities in the development of the endometrium identified during the IVF program?
7. Has implantation occurred, as determined by a blood test for the hCG hormone two weeks after embryo transfer?
8. Why didn’t pregnancy occur (although there is no answer to this question!).
9. Do I need to do any additional testing before my next IVF attempt?
10. Do I need to do any treatment before my next IVF cycle?
11. Can the same treatment regimen be repeated or does it need to be modified before trying again?
12. When can I start a repeat IVF cycle?

Even if you don't get pregnant, the very fact that you went through IVF will allow you to move on with your life knowing that you did the best you could using the latest technology that modern medicine has to offer.

Repeated IVF cycle

Most doctors advise waiting at least one month before starting next cycle treatment. Although it is medically possible to repeat the IVF cycle as early as next month, most patients need a break to gather their strength and regain their peace of mind before starting all over again. As a general rule, we recommend a three-month break before attempting IVF again.

Depending on the results of the previous cycle, your doctor may need to change your treatment regimen. For example, if the ovarian response to stimulation was insufficient, the doctor may increase the dose of the drug to stimulate superovulation or change the stimulation protocol. If fertilization does not occur, you may need ICSI. If egg quality has been poor, your doctor may recommend using donor eggs. However, if the results of the previous cycle were satisfactory, the doctor may recommend repeating the same treatment regimen: all that many patients need to succeed in an IVF cycle is time and one more try.

It is interesting to note that couples undergoing a repeat cycle of IVF tend to be much calmer and more in control of the situation. This may be due to the fact that they are already aware of all the necessary medical procedures, and better prepared for them; and also because they have already established personal contact with the doctor and staff IVF center.

Unfortunately, none of the ART methods is a 100% guarantee of pregnancy. According to statistics, the success rate of IVF ranges from 30 to 60% depending on the patient’s age, the number and quality of the embryos obtained, as well as many other individual factors and the condition of the body. However, do not despair if the initial attempt is unsuccessful. You have every chance to achieve the desired result in a repeated protocol; the main thing is to analyze the reasons for failure and find the right approach.

Nowadays, the IVF procedure has become more accessible as a treatment method, more in demand and, to a certain extent, less dangerous, thanks to the accumulated knowledge and experience of reproductive specialists. More than 4 million children around the world have already been born thanks to IVF and other types of ART. In parallel with this, the level of clinics providing these services is increasing, and the range of programs and opportunities for conceiving a child in the most seemingly hopeless conditions is expanding.

Competent analysis of previous stimulation protocols, as well as subsequent stimulation of superovulation by an experienced reproductive specialist who regularly monitors general state patients and the ovarian response to stimulation - reduces the risks of complications to a minimum, and the effectiveness to a maximum.

Reasons for failure in IVF:

1. One of the most common reasons failure to get pregnant after IVF is the quality of the embryos. It depends both directly on the quality of gametes (oocytes and sperm) and on external factors, important of which are the level of equipment of the embryological laboratory, the qualifications and experience of embryologists, and the quality of the media used. Awareness of the patient about these parameters is important before making a decision in which clinic to conduct subsequent IVF attempts. Having its own genetic laboratory and full-time specialists - geneticists, urologists-andrologists, therapists, psychologists - is a big plus for an ART clinic, since only with an integrated and competent approach can the success of the procedure as a whole be ensured.

2. For successful implantation important has an endometrial condition at the time of embryo transfer. The most a common question The patient’s question before the transfer is “has the endometrium grown well enough?” To date, there is no clear answer as to how large the endometrium should be before transfer. It is necessary to understand that the thickness of the endometrium is not as important as its timely transformation, structure and receptive activity. There is the concept of an implantation window - these are the days of your own or prepared cycle in which embryo implantation is most likely. Each woman has this window individually, and it is most promising to adhere to natural cycle. However, in its absence, a reproductologist will always “support” the endometrium with hormonal drugs, both in the first and second phases, and will also monitor the level of his own hormones, which will allow him to choose optimal time for embryo transfer. Independent and uncontrolled use of hormonal drugs can result not only in failure to achieve pregnancy, but also in serious health problems.

It is important before the IVF procedure to exclude infectious pathology of the endometrium - chronic endometritis. Chronic infections of viral-bacterial origin, often asymptomatic, activate immunological reactions and disrupt local vascular processes in the endometrium, preventing embryo implantation and contributing to early pregnancy miscarriages. Experienced specialists performing a pelvic ultrasound can identify indirect signs of chronic endometritis. This assumption can only be confirmed by histological examination of the endometrium, the material for which can be obtained using outpatient pipell bopsy or hysteroscopy. The choice of one method or another depends on the presence of additional suspicions of endometrial pathology - polyps, endometrial hyperplasia, etc.

3. Pathological changes fallopian tubes - hydropyosalpinxes (overstretched fallopian tubes filled with fluid) are sometimes the cause of unsuccessful IVF. Stimulation of the ovaries can provoke their growth and an increase in the source of infection, with all subsequent adverse consequences. Tactics for removing such pathological formations before the procedure, IVF has proven itself successfully and is highly recommended, especially when preparing for repeated attempts.

4. Genetic problems.

Karyotyping of spouses - a study of the chromosome set - is one of the most important studies, especially if a couple fails in IVF one after another. Pathological cryotype (different from 46XX in women or 46XY in men) can be the reason for failure to get pregnant. Carriage of certain chromosomal mutations in parents can negatively affect the offspring, therefore, if parents are aware of this pathology, preimplantation genetic diagnosis is recommended. The procedure for determining qualitative and quantitative changes in the chromosome set of an embryo can increase the chances of pregnancy up to 65% and reduce the risks of early losses. At the Next Generation clinic, preimplantation diagnostics is carried out using the Array CGH method, which allows simultaneous diagnosis of all pairs of chromosomes in the embryo.

5. Endocrinological problems

One of the factors for the unsuccessful outcome of IVF can be diseases of the endocrine system. Consult an endocrinologist in advance and inform your fertility specialist about existing problems.

6. Immunological disorders

Long-term infertility and repeated failures in IVF can be caused by a number of immunological disorders. One of the most important may be the relationship between spouses at the level of histocompatibility antigens (the so-called HLA - human leucocyte antigen)

Normally, the incompatibility of spouses in HLA antigens and the difference between the fetus and the mother’s body is an important point necessary for maintaining and carrying a pregnancy. During the normal development of pregnancy, “blocking” antibodies to paternal antigens appear from the earliest stages of pregnancy and determine its normal course.

The similarity of spouses in histocompatibility antigens leads to the “identity” of the embryo to the mother’s body, which causes insufficient antigenic stimulation of the woman’s immune system, and the reactions necessary to maintain pregnancy are not triggered. The embryo is perceived as a foreign agent, which leads to the initiation of termination of pregnancy.

7. Excess weight.

Excess weight and obesity adversely affect all stages of the IVF procedure, the subsequent development and gestation of pregnancy. Consultation with a nutritionist and endocrinologist for overweight required before planning a protocol. Often, weight loss of even 5-7 kg leads to dramatic changes in IVF outcomes

8. Age.

The reason for unsuccessful IVF may be the age of the patient. In women over 40 years of age, the effectiveness of each subsequent attempt, unfortunately, drops sharply. The reason for this is age-related changes in the chromosomal apparatus of eggs. For such patients, we strongly recommend that during an IVF cycle, preimplantation chromosomal screening of embryos using the method of comparative genomic hydridization is carried out in order to detect and transfer only viable embryos into the uterine cavity. If there are none after the study, we are always ready to offer alternative programs using donor material.

Let's take a closer look at the benefits of a repeat IVF procedure at NGC in case of negative result previous attempt

• Stimulation of superovulation. Be sure to take the previous stimulation protocol with you. Experienced fertility specialists at the clinic will analyze possible reasons failures and will select the most appropriate therapy. Our clinic's pharmacy is equipped with all necessary medications according to the most affordable prices. Storage conditions for medications are carefully monitored. The clinic’s medical staff will always advise and teach you how to properly handle injectable drugs, since timely and correct administration of medications determines adequate maturation of follicles in the ovaries.
• Puncture. Correctly chosen puncture date is the most important component of success. Receiving immature or degenerate eggs, unfortunately, leads to the impossibility of their fertilization and failure of the program. The lion's share of success depends on the patient's discipline and strict adherence to the medical instructions of the attending physician. If additional explanation of the appointments, time, dosage and other features of the protocol is required, it is always worth asking clarifying questions to the doctor or medical staff of the clinic. Don’t be shy, an extra question is another step towards success!
• Fertilization. Our embryologists carefully care for each patient’s egg. Saving on media for fertilization and embryo cultivation is not our rule. To improve the effectiveness of ART programs, the board of doctors and embryologists of our clinic decided to use specialized environments for all groups of patients, which are used all over the world to overcome infertility in patients of advanced reproductive age.
• Embryo cultivation. Embryo cultivation in our clinic is carried out in incubators with a multi-gas mixture, which is a significant advantage compared to the use of CO2 incubators. We are proponents of transferring 5-day embryos. In addition, our doctors are unequivocal supporters of the transfer of only one embryo (SET-single embryo transfer).
• Embryo transfer. The most important stage IVF procedures. The doctor’s experience is of no small importance in this manipulation, as are the conditions under which the transfer is carried out. After embryo transfer, we recommend leading a normal, active, more moderate lifestyle, avoiding significant physical and emotional stress. However, we are not adherents bed rest after embryo transfer, as well as excess administration medications(polypharmacy). All therapy after the transfer has its own rationale and is prescribed exclusively according to evidence-based medicine.

So, summing up this section, we recommend that our patients do not despair, but after analyzing the reason for the negative result, when trying IVF again, trust experienced reproductologists and believe in success, since a lot depends on your attitude and self-confidence!

There are many cases where an IVF attempt fails. There are many reasons for this phenomenon. Sometimes it is even impossible to name the exact pathology that provoked such consequences.

For many women, the problem of struggling with infertility becomes the main one. life goal, to which, against all odds, they go. For many, the methods are auxiliary reproductive technologies became the light at the end of the tunnel and gave the long-awaited happiness of motherhood and fatherhood. However, the in vitro fertilization protocol does not always end with the birth of such desired children. There are many cases where an IVF attempt fails. There are many reasons for this phenomenon. Sometimes it is even impossible to name the exact pathology that provoked such consequences. In this case, there is no need to argue that IVF is a sin.

Repeated IVF: chances

You shouldn't give up on your dreams because of one failure.

If a woman has undergone the first IVF protocol and the pregnancy does not occur or is interrupted, do not despair. Statistics show that subsequent attempts have a much greater chance of success. This is explained by the fact that fertility doctors can identify the cause of failure and prevent it in the next attempt. Don’t despair, ovulation will still happen after an unsuccessful IVF. You shouldn't give up on your dreams because of one failure.

IVF protocol: reasons for failure

There are many reasons for unsuccessful attempts at in vitro fertilization, however, we will highlight the most significant:

• 1. Pathological processes of the endometrium are one of the main reasons for disruption of the processes of implantation of a fertilized egg.

After the union of the egg and sperm, the embryo is cultured. The next step is the transfer of the resulting embryo into the uterine cavity, where it should be implanted into the endometrium. This is the most important stage in the process of pregnancy with the help of assisted reproductive technologies. And whether this implantation will be successful or not depends on what kind of endometrium lines the uterine cavity.

Normally, the endometrium should have sufficient thickness and secretory transformations in the form of glycogen accumulated in the cells.

However, in some cases inner surface the uterine cavity is not characterized by such qualities and in this case the embryo does not attach. The reasons for IVF failure are very individual.

Some causes of endometrial deficiency:

• ovarian-menstrual cycle disorders - hormonal imbalance due to pathological processes of the reproductive system. As well as extragenital pathological conditions leading to hormonal imbalance;
• hyperplastic processes of the endometrium in the form of endometrial polyps;
• benign neoplasms such as leiomyoma of the uterine body, especially with submucosal nodes, which are a significant obstacle to the process of implantation and further pregnancy;
• surgical interventions on the uterus, including medical abortions by curettage of the uterine cavity;
• the presence of synechiae in the uterus - pathological adhesions of the walls of the uterus;
• transferred endometritis – inflammatory processes endometrium;
• presence of scars on the uterus;

What should be done to ensure that the second IVF is successful?

IN in this case diagnostic value for endometrial pathologies there are methods such as ultrasound diagnostics, with which you can measure the thickness of the endometrium, suspect the presence of hyperplastic processes, and, depending on the results obtained, correct the existing pathological condition that led to such consequences. Hysteroscopy also has high effectiveness rates, but this manipulation already refers to minimally invasive surgical interventions.

• 2. One of the most common reasons for protocol failure is a variety of infections that can cause both pathologies of the reproductive parent cells, embryo, and endometrial pathologies. Therefore, a very important point is preconception examination in order to identify and timely treatment these infections.
• 3. Repeated IVF in case of failure due to the presence of tubal factor.

The presence of fallopian tubes is of great importance for the onset of spontaneous pregnancy, but, no matter how strange it may sound, it can also cause failure when trying to get pregnant using assisted reproductive technologies. The presence of fallopian tubes can lead to the occurrence of ectopic, in this case, ectopic pregnancy. Women who came for the IVF protocol due to various reasons cannot become pregnant naturally, therefore, due to the danger of ectopic pregnancy, the inability to spontaneously become pregnant, when performing in vitro fertilization, bilateral laparoscopic tubectomy is recommended - removal of the fallopian tubes using laparoscopic technologies, which poses a health hazard to IVF.

• 4. Repeated IVF after a failed first protocol due to endocrinopathies after stimulation




When performing in vitro fertilization to obtain several eggs, drug stimulation of the ovaries is performed with powerful hormonal drugs. Endocrine system Not every woman is able to withstand such loads. Sometimes there are complications such as significant hormonal imbalance, ovarian hyperstimulation, especially its severe form, which does not allow for a normal pregnancy.

• 5. Another secret to successful IVF is high-quality, viable embryos.

The transferred embryos themselves play a huge role in IVF, the viability of which directly depends on the quality of the source material - the egg and sperm. The characteristics of the reproductive material may be influenced

• age indicator of mother and father;
• genetic and somatic pathologies of parents;
• the presence of bad habits and the lifestyle of the parents;
• 5. Second IVF due to chromosomal abnormalities

The percentage of complications such as chromosomal abnormalities during IVF is small. It accounts for about 1% of all cases. Required condition when using assisted reproductive technologies, genetic counseling and karyotyping of both the woman and the man in a couple are carried out. Using this procedure, the chromosome sets of spouses are examined and the likelihood of chromosomal pathologies in the future offspring is calculated.

But in order to exclude even this one percent of complications, before embryos are transferred into the uterine cavity, they must be subjected to preimplantation genetic diagnostics, in which embryos with chromosomal abnormalities will be identified and excluded from possible transfer.

• 6. Immunological infertility as a factor influencing failures in the IVF protocol.

With development modern techniques The diagnostic industry is experiencing an increase percentage immunological infertility in general structure this problem. The immunological part of infertility in females is associated with the occurrence immune complexes, as antisperm antibodies, which are found on sperm that perceive male reproductive cells as antigens. Which the body must fight. Actually, using these antibodies, the woman’s body eliminates them.

Reasons for the formation of immune complexes in women

The mechanism of the formation of immune complexes against male sperm has not been studied. Due to the influence of provoking factors, the women’s body perceives it as a foreign agent. Normally, sperm has properties that are characterized by a slight immunosuppressive effect, so no reaction occurs in the physiological course of the fertilization process.

Therefore, you should not forget about the immunological cause of infertility and be sure to take it into account when infertility of unknown etiology occurs, this also applies to IVF for the second child.

• 7. Coagulopathic disorders are not the least important cause of IVF failure. The reasons for such pathological conditions there may be both hematological problems and various pathological processes as antiphospholipid syndrome, which is especially pronounced during pregnancy and is characterized by increased thrombus formation. Both in the early stages and later, there is a high risk of thrombosis of the umbilical cord vessels, then frozen pregnancies occur, antenatal fetal death in more late dates, with thrombosis of placental vessels - placental abruption.
• 8. The age of the parents is also a very important factor in the success of the use of assisted reproductive technologies. Women over 40 years of age have a high risk of developing chromosomal abnormalities in their offspring, endocrine and reproductive system older pregnant women may respond inadequately to a developing pregnancy; a lack of hormonal factors may negatively affect the outcome of this pregnancy. The younger the woman, the Great chance successful in vitro fertilization protocol.

The age of a man is also important, since every year after 40 years the quality of sperm deteriorates, which also negatively affects the quality and viability of the resulting embryos using such genetic material.

• 9. Excess weight a woman's body is a significant obstacle to the onset of desired pregnancy. Firstly, when ovulation is stimulated, excess adipose tissue does not give the expected result, the effect of prescribed hormonal drugs on the ovary. The effectiveness of IVF is reduced significantly. Secondly, adipose tissue is an additional source of estrogens, hormones that can cause endometrial hyperplasia, which can also cause failure in the process of embryo transfer and implantation.

Before planning a pregnancy using assisted reproductive technologies, a woman must carry out a correction metabolic disorders, lower your body mass index to successfully get pregnant and give birth to a healthy baby. After all, bearing a pregnancy is sometimes harder than getting it. And in the presence of obesity during pregnancy, many complications can occur in the form of gestosis, preeclampsia, gestational hypertension, gestational diabetes mellitus, which cannot but affect the fetus itself.

No different from the previous time.

For infertile families, especially those who have experienced an unsuccessful attempt at in vitro fertilization, perhaps the only chance of finding happiness is the Federal program for free IVF at the expense of the compulsory medical insurance fund, including repeated IVF under compulsory medical insurance. This program gives hopeless families a chance for a happy future surrounded by children's laughter.