When advanced fertility treatment fails

Dear doctor,
I am desperately depressed after going through 3 failed advanced fertility treatment cycles. Do I have other options, or should I give up and just live childless?

Advanced fertility treatment is commonly referred to as test-tube babies. The scientific terminology is In-Vitro Fertilization (IVF). In simplified terms it means fertilization takes place outside the body, in highly regulated and specialized labs. Once the eggs are fertilized, they become embryos, and are then allowed to grow in the lab for a few days before being placed into the woman’s womb (uterus).

The availability of IVF has helped many couples, who would otherwise have remained childless. There are many reasons why couples may require IVF, ranging from simple to complex fertility problems. Even though IVF techniques have been refined over the years, many couples will go through IVF and still end up without a child. The frustrations of failure are not helped by the financial and emotional burdens of IVF treatment.

So why does IVF treatment fail? There are several steps to be followed during IVF treatment, lasting a few weeks. Each of these steps are critical to eventual success, and any sub-optimal response in any of the steps will influence the final outcome. Some women may produce less number of eggs, and of poor quality. The sperm numbers and quality may also be low. Such a combination would lead to poor fertilization and lowered potential for pregnancy. Once embryos are placed into the uterus, a pregnancy may not ensue, often referred to as failed implantation. Some women will get pregnant, only to end up with an early miscarriage.

Once an IVF cycle fails, attempts must be made to try and pinpoint the likely reason for the failure. You must arrange to meet your fertility team and critically review the failed cycle. Each component step of your treatment must be re-evaluated, in attempts to explain why the failure occurred. Alternate approaches must be defined for subsequent treatment, especially if any apparent gaps become evident. In some cases, it may turn out that everything was optimized from the outset, with no new modifiable approaches. That can be very frustrating, with no apparent reason for the failure.

Subsequent actions following the review depend on several factors. You could decide to try again with your current fertility team. Or you could seek another view with an alternate fertility clinic. If you decide the latter, get a summary of your treatment from the initial clinic as this forms the basis for alternate recommendations. True, 3 failed cycles can be an uphill task. You may decide to halt further treatments and possibly consider adoption. Or as you say, just accept to live childless. The psychological trauma can be daunting, some counselling sessions may come in handy to help you cope with the disappointments.