1st time failure - Ghost or anybody

[Panama]

I just completed my first attempt at IVF/ICSI. After the 2ww the pregnancy test was negative. We are naturally hurt and disappointed. This was a male factor situation. My husband had a sperm aspiration due to a blockage. The sperm taken was healthy, plentiful and all displayed good, mature shape. The amount taken was enough for 5 IVf cycles. I am 36 yoa, very healthy, with no medical problems.

All of my ultrasounds were good, the protocol with the Gonal F and Lupron produced the right lab numbers, and 15 mature eggs were retreived. 5 took the fertilization and two developed into very well defined, shaped blastocycsts. I had the two 5 day embryos transferred and was told "they were put right were they needed to be." I followed the treatment to the letter and was always led to believe that everything (uterine wall and lining, husband's sperm, ovaries, follicles, eggs, lab readings, transfer, etc) was exactly as it should be for optimum results. With all that being said, what should I be asking the doctor and staff???

Right now I am feeling abandoned by the clinic we chose. I know results cannot be guaranteed, but for the money we spent, am I out of line to expect a full out brief from the doctor as to possible cause of failure, what could be done differently, and possible courses of action for future attempts? Any inputs or suggestions are greatly appreciated.

[Ghost]

I just completed my first attempt at IVF/ICSI. After the 2ww the pregnancy test was negative. We are naturally hurt and disappointed. This was a male factor situation. My husband had a sperm aspiration due to a blockage. The sperm taken was healthy, plentiful and all displayed good, mature shape. The amount taken was enough for 5 IVf cycles. I am 36 yoa, very healthy, with no medical problems.

All of my ultrasounds were good, the protocol with the Gonal F and Lupron produced the right lab numbers, and 15 mature eggs were retreived. 5 took the fertilization and two developed into very well defined, shaped blastocycsts. I had the two 5 day embryos transferred and was told "they were put right were they needed to be." I followed the treatment to the letter and was always led to believe that everything (uterine wall and lining, husband's sperm, ovaries, follicles, eggs, lab readings, transfer, etc) was exactly as it should be for optimum results. With all that being said, what should I be asking the doctor and staff???

Right now I am feeling abandoned by the clinic we chose. I know results cannot be guaranteed, but for the money we spent, am I out of line to expect a full out brief from the doctor as to possible cause of failure, what could be done differently, and possible courses of action for future attempts? Any inputs or suggestions are greatly appreciated.

I'm sorry to hear this. It happens all too often. Even when everything seems perfect, half of IVF cycles still fail. Nobody ever really knows why. Bad embryos arrested right after transfer? Non-receptive endometrium? No way to know for sure.

The clinic will typically take some guesses and start changing things. They might suggest genetic testing to verify the embryos are normal.

Even then, many chromosomally normal embryos still fail to implant, and some that implant fail to make it all the way to live birth. There are clearly other factors besides embryonic factors.

In fact, embryo biopsy causes a little bit of damage to the embryo, so you may get fewer blastocysts and a reduced chance of success if they do genetic testing on the embryos.

Something ironic is that, if you do repeated cycles and finally succeed, the impression will be that the last change was the key to success. But there are so many uncontrolled variables involved, there is usually no way to know if the last change was relevant at all. Maybe. Or maybe it was just luck and would have happened anyway?

Sorry, I'm rambling on.

You have many options. Donor sperm, maternal and paternal genetic testing, embryo biopsy, and more. Your clinic will have a much better idea than I do about which of these is most likely to benefit you. Keep in mind, even if they feel they are 90% sure, it's still a guess, and even when they address everything they can with current technology, some IVF cycles still fail.

You did everything right. It's important not to blame yourself. Your clinic may have done everything right, too.

[Panama]

Ghost - Thank you for your reply. It helps and I understand that almost half or less of all first time IVF cycles result in failure. I was just looking for something a little more detailed from my clinic than sorry.......like a way ahead or "here's whats next." In thinking about our 2nd attempt, we have already schedule an appointment with a different clinic and are looking at others. Assuming all things are equal, however, can one clinic and doctor(s) really perform and produce results better than the next?

[Ghost]

Assuming all things are equal, however, can one clinic and doctor(s) really perform and produce results better than the next?

Clinics do vary in success rates. Most of the variation in success rates between clinics is due to patient selection (some clinics accept only good patients, even some clinics who claim they take everyone) and due to increasing the number of transferred embryos (increasing the risk of triplets and such). Neither of these practices is really a benefit to the patient.

But there are some real differences. Some will stim a little more or a little less than others. The techniques for avoiding OHSS in high-risk patients vary. Some pay attention to endometrial receptivity. Some are big on acupuncture, immune testing, and/or genetic screening. Some do blastocyst transfer, other do day 3. Blast culture is usually more expensive, but they implant more reliably, reducing the need to transfer so many embryos (with blasts, it's common to transfer 1 or 2, with day 3 it's common to transfer 2 or 3).

[lisa10]

My office had us schedule a consultation with the RE 3 weeks after ER regardless of the outcome. I would ask your clinic for a consult or find a new clinic if they disagree with your request.

You will be in my prayers that everything works out for you.