When the cycle does not end with pregnancy

What happens if pregnancy is not achieved in the first IVF cycle?

A couple’s first IVF cycle is also considered diagnostic.

It is important to assess:

• ovarian response
• the quality of the oocytes and the proportion of mature oocytes
• the fertilisation rate with IVF and ICSI
• embryo quality.

If the patient has not become pregnant, we will be able to guide the next treatment more appropriately. If all this has been correct then it is advisable to repeat the cycle in the same way.

Is it possible to have a uterine alteration that hinders the implantation of the embryos?

Yes. If pregnancy has not been achieved and the embryos have looked good, it is advisable to complete the implantation study. We know that there are multiple substances (hormones, proteins, genes, etc.) involved in the process that allows the embryo to adhere and penetrate the endometrium (inner layer of the uterus) in order to implant, but most of them are still unknown; there is currently a lot of research on this subject.

The tests available for the study of endometrial receptivity are: hysteroscopy, endometrial biopsy, cultures of Chlamydias, Ureaplasma and Mycoplasma, and colour Doppler ultrasound. These are done to rule out abnormalities in the uterine cavity, infections (these endometritis do not usually produce symptoms) and alterations in vascularisation.

What can be done if pregnancy has not been achieved after several IVF cycles?

According to statistical data, the chances of pregnancy decrease after three IVF cycles unless variations in the treatment are made.

After three unsuccessful IVF cycles, changes are recommended:

• Sequential cultures and observation of embryo development with EMBRYOSCOPE; that is to say, to let the embryos evolve in the laboratory and constantly follow their development to the blastocyst stage until day 5 or 6. This allows us to select the embryos with the greatest developmental potential and they reach the endometrium at the moment of maximum receptivity.
• Assisted hatching, which consists of techniques that facilitate the exit of the embryo from the membrane that surrounds it, thus facilitating implantation.
• Preimplantation diagnosis, studying the genetic composition of the embryos before transferring them. We know that approximately 72% of the embryos of these couples have chromosomal abnormalities.
• Donation of oocytes or sperm.