No one likes to consider the possibility of an IVF cycle not resulting in pregnancy. The reality is, however, that at least 30-40% of the time, it will not. After the emotional dust settles, it is very important that we sit down and critically review the treatment cycle to try to learn more from the experience. We call this a “failed cycle meeting”. A failed cycle meeting is just as important as the actual treatment cycle. In the meeting, all aspects of the treatment cycle will be reviewed.
The review should evaluate both embryonic reasons for IVF failure and environmental reasons:
- Embryonic reasons will evaluate any potential problems with the eggs, sperm and/or embryos that might have resulted in the lack of pregnancy or miscarriage. Things such as the protocol (medications and dosages used), number of follicles, estrogen levels, size of follicles at the time that hCG was given, number of eggs obtained, egg maturity, fertilization rate, percentage of embryos that progress to blastocyst (implantation stage, typically day 5 or 6 of embryonic life) and quality of the blastocysts (this can include genetic testing of embryos- called complete chromosomal screening (CCS)). Problems in this area might be due to egg quality or the type of stimulation utilized. Sometimes, adjustments can be made to the stimulation protocol that might ultimately improve embryo quality and pregnancy outcome.
- Environmental factors are also an important aspect of the failed IVF cycle meeting. This area will include things such as the preparedness of the uterus (endometrial thickness and structure), immune factors (including both autoimmune and alloimmune problems) as well as the embryo transfer. Immunologic factors can be tested using parental blood and might include tests such as antiphospholipid antibodies.
These areas will be discussed openly and honestly so that any future IVF attempts can be revised to improve the chances of a positive outcome. The point here is to have an opportunity to put our heads together, and allow you to ask questions in order to improve the chances for pregnancy on your next IVF attempt.