Blastocyst transfer may help in repeated IVF failure cases

Recurrent implantation failure may identified after three failed IVF cycles or after transfer of 10 high grade embryos. There are many different factors which may contribute for this recurrent IVF failure, such as parental chromosomal translocations, abnormal uterine anatomy , hydrosalpinx, or inadequate  culture conditions or embryo transfer techniques.

Failure may be due to factors with the “Seed,Soil or the Cultivator”

Some studies have suggested that local injury of the endometrium by means of a catheter or hysteroscopy can induce an inflammatory response that may facilitate the preparation for implantation.

Artificial rupture of the covering of the embryo ( Zona pellucida) may improve implantation: Assisted Hatching, but is still not proved.

Pre-implantation genetic screening of the embryos is now a day used to get and select best embryos. But this strategy did not show any improvement in patient outcome  and did not show any significant difference on clinical pregnancy rates.

A few studies have reported that congenital and acquired prothromotic conditions are more prevalent in women with recurrent implantation failure. Therefore use of low molecular weight heparin (LMWH) and mini dosage of aspirin on patients with thrombophilia and recurrent implantation failure has been discussed, but large studies are required to prove them .

Finally, another possible strategy is to extend embryo culture to blastocyst stage, aiming to improve embryo selection and uterine receptivity

Role of emotional stress in fertility treatment

I see my patients (not patients, as they are healthy couple,but not able to reproduce) come for infertility treatment, and most of them are for IVF. They tried for a  long, naturally or with various treatments but feel helpless, as they couldn’t achieve it. So I can place them in psychologically stressed and partly frustrated.

“Rene Frydman and Alice Domar have emphasized the role of emotional stress( the stress of infertility has been compared to a diagnosis of cancer or infection with human immunodeficiency virus) in reducing oocyte competence.

Any stress, like ” Fight,Flight, Fright” generates a response, that mobilizes blood flow to the heart, muscles, and brain at the expense of ” inessential” organs such as ovary.  Frydman’s group in Paris showed in a landmark study of natural cycle IVF that the quality of blood flow to the mature follicle was strongly related to pregnancy outcome.They also refer to  another landmark study showing that an increased vascular response to stress predicts a reduced IVF pregnancy rate

Thus the patient has to be counseled to reduce the amount of stress during IVF treatment. Because it is our opinion too that, even we get good eggs and even we get good blastocyst, the implantation fails. It may be due to poor quality or poor energy(? mitochondrial energy) of the maternal oocyte.” ( Fert-Ster,page 545,Vol 105,No3/March 2016)

Extreme stress is a major contributor to the poor embryo quality and failed IVF.

Many female partners, in my center, seeking IVF treatment, are under too much stress . When I ask them for the reason, apart from infertility, few of them disclose that , they have a fear of left out by male partner and his family, because she is infertile and if this expensive treatment fails, they might be discarded by the family ( may not be an actual truth, but the guilt of being infertile breaks them)

Fear of loosing hard earned money, if treatment fails, is one of the major contributor of stress, in a self funding situation.

And top of that, when one IVF cycle fails, and they decide to go for second cycle, there is an added stress of previous failure.

I always try to communicate with the female partner and try to make her comfortable. I always tell them, when you are under my treatment, then we are friends, there is no doctor-patient relationship, we have to be informal in talking, and I am always available with you,any time you need any answer. It makes the situation little less stressful ( I suppose). I can not behave like or become a God, but we together can bang the door of “Him”, so that it may open the door of opportunity. If we don’t bang it with fullest effort, it will never open. To get a pregnancy, is our joint goal,  and with you guys, I am too very much fond of success.

I always ask them to do “meditation” ( a mind-body program). Sometimes I teach them, how to do it. It helps to release stress to a large extent.

I tell my patients, that while doing your treatment,I am under stress too ,  Because it is a great responsibility to give best from my side. I don’t know whether my treatment will be successful or not, but I have to overcome this stress and do my best, rest depends on “Almighty”. It is our philosophy, ” You do you best Karma, and for the result, leave it to the Almighty”. It is like a war. You always fight it to win it.

People have seen that: Even the Best Euploid embryo , diagnosed by Pre-implantation Genetic Screening , fails to implant in good endometrium. (Fert-Ster page 545,Vol 105,No3/March 2016)