This is the first in a series of responses to common questions about Failed IVF Treatment.

Question #1: Could I have done anything to prevent failure?

When an IVF cycle fails, the disappointment is enormous. The first two questions that patients ask are “Was the medical treatment inadequate?” and “Could I have done something wrong?” This post will address the latter.

Could stress have played a role? While stress can and does have the ability to effect normal spontaneous ovulation and the hormonal changes that surround this event, it does not effect the response to hormones during controlled ovarian stimulation (COS), nor will it influence egg quality or the ability of a transferred embryo to implant in the uterine lining. Thus, stress can only be a factor when it comes to natural cycle IVF.

Could I have administered my IVF medications at the wrong time or in the wrong way?
While this is always a possibility, it is rarely the reason for IVF failure. Most competent IVF clinics devote a great deal of time and effort in explaining exactly how to prepare and dispense medications appropriately and the exact timing of such administrations. Granted, patients sometimes oversleep and forget to take their drugs at the right time, but this, (with the exception of the timing of the hCG “trigger” shot) is rarely problematic. Whether fertility drugs are taken a few hours earlier or later than directed to do hardly matters in the larger scheme of things. However, failure to take the hCG shot or doing so at the wrong time can be disastrous. We have found that forgetting to take the hCG shot at all, although rarely encountered, is more commonly seen in the case of egg donors who often do not have a personal vested interest in the outcome of the IVF cycle. For this reason, we routinely see egg donors the morning after the hCG shot and do a urine test to confirm that they have indeed taken this medication. Recently we had a regular IVF patient who came all the way from England for treatment with me in Las Vegas. She had the most beautiful follicles by ultrasound and an excellent blood hormone response. When at egg retrieval I was unable to extract a single egg, I immediately suspected that she had failed to take her hCG or had neglected to do so at the right time. So I did a blood hCG test and it was negative. The patient had inadvertently administered only the water solution and had not mixed it with the hCG powder and accordingly none of the medication reached her blood system. In the absence of the hCG trigger, the cells that bind the egg to the inner wall of the follicle do not disperse and the egg remains attached and does not come free at the time of aspiration.

Might I have knowingly harmed my chances through ingesting drugs or alcohol?
This is highly unlikely to be a cause for failure. Prolonged overuse of caffeine does increase the risk of miscarriage somewhat, but it should not be a cause for failure to conceive following IVF. Similarly, the use of alcohol or even prescribed or non-prescribed drugs during COS will almost never affect egg quality. Remember, your eggs have been in your body ever since you have been in your mother’s body and thus recent exposure to substances should not compromise their quality. Long term use (and/or abuse) is another matter all together. In most cases, I recommend that patients who are on routine regimes of medications that could effect embryo implantation, stop taking these prior to embryo transfer and wherever possible stay off of them until the end of the first trimester at least.

Could my weight, general physical health, or activity level have played a role?
Women who are overweight (see my prior post on Obesity and IVF Success) and have an elevated BMI (above 25) tend to have more difficulty in absorbing medications. This is because certain drugs such as progesterone in oil and hCG that need to be administered by deep injection (i.e., into the muscle) are more likely to do so when the needle is introduced strategically into areas where the muscle is closer to the skin (i.e., in the upper outer quadrant of the buttock, in the thigh or in the deltoid muscle of the shoulder). A high BMI probably does not matter when it comes to subcutaneous shots such as the fertility drugs (agonists, antagonists, gonadotropins). It is rarely if ever necessary to increase the dosage of drugs administered because of body size or BMI.

Women who have a low BMI are not at risk when it comes to drug absorption. In some cases, women have a very low BMI with very low body fat. This can happen because of over exercising or with certain eating disorders such as anorexia nervosa or bulimia. These cases do present significant problems that should be aggressively addressed before the woman undergoes fertility treatment. Needless to say, any woman who undergoes IVF with the intention of carrying her baby to term needs to be healthy enough to accomplish this goal. It is for this reason that women undergoing IVF need to have a full medical evaluation before initiating treatment.

Did my partner do something that could have adversely affected his sperm?
It is very uncommon to get surprises when it comes to the man’s sperm quality. The reason is that sperm have a developmental life cycle spanning 3 months. Thus, it is unlikely that alcohol, smoking or drug abuse in the few days prior to IVF will impact on the quality of sperm formed quite some time prior. So ladies, while it is often convenient to blame the failure of your IVF cycle on your partner having partied the night before the procedure, this is rarely justified. Now, if the man is unable to produce a sperm specimen on the day of egg retrieval, that is another matter altogether. Here, partying the night before or severe stress in anticipation of the pivotal role he must play on the day of egg retrieval could be a factor. In such cases, there are always other methods by which sperm can be obtained. The simplest is to involve the female in helping her partner reach ejaculation. This usually works well. In the worst of circumstances, sperm can be obtained directly by needle aspiration from the testicle in a process referred to as testicular sperm aspiration (TESA). The latter is fortunately very, very rarely necessary.

It is very infrequent for an IVF cycle to fail because of a patient being non compliant when it comes to following medical directions. However, it is very important for patients undergoing IVF to make certain that they fully understand all the directions given them by the medical staff in attendance.