If At First You Don't Succeed...

In the past 8 years that I have moderated the IVF and High Tech Pregnancy Bulletin Board on the INCIID website, the most frequently asked question has been: Should I try again? A simple question but one that is so difficult to answer. The costs of fertility treatment are financial, physical, emotional, psychological and social. Fertility treatments can consume people and wreck marriages and relationships as well as drain your bank balances quicker than the Nigerian Foreign Minister who only needs your bank account number and social security number to park $30 million dollars for a few days….

So how can we answer this question. I usually review the reasons for IVF, the outcome of the cycle and look at all options. At some point it is appropriate to consider other paths: adoption, donor egg, donor sperm, child-free living, etc. One of our most important jobs as physicians is to advise when to move on and stop being a professional fertility patient. Of course, if we make that recommendation and the patient goes to another clinic and delivers a baby then we get slammed all over the internet, but what can we say except that no one has all the answers…


Here is a joke that I may have already told:


Question: What is the difference between God and a Reproductive Endocrinologist?


Answer: At least God knows that He is not a Reproductive Endocrinologist!

Since I am not God and do not have all the answers all I can provide is today’s Question of the Day:


77. My last IVF failed. Should I try again?


To make the best decision about whether to do another IVF, your first step is usually to sit down with your doctor and re- view your history and the details of the failed cycle. This would include a discussion of the rationale behind attempting IVF in the first place and a careful examination of the results of the IVF cycle.

Clearly, if a woman can conceive only through the use of IVF (for example, because she has no fallopian tubes or because her male partner’s sperm is of such poor quality that no other alternative is available), then the decision becomes one of whether another attempted IVF is warranted. In reviewing the previous IVF cycle, the woman’s response to the stimulation protocol should be carefully examined as well as the findings at the time of egg collection. If the eggs appeared immature at the time of egg collection, then in the future the trigger shot should probably be withheld until the follicles reach a larger diameter. If the stimulation and number of eggs are appropriate but fertilization was unexpectedly poor, then the use of ICSI for a future IVF cycle could be considered. If stimulation, fertilization, and embryo development were good and yet the cycle still failed, then consideration should be given to either an FET cycle (if appropriate) or a repeat cycle of IVF. If the stimulation was poor and the number of eggs was suboptimal, then other stimulation protocols should be discussed. If maximum doses were used and a poor response was still seen, then IVF may not be an appropriate choice; in such a case, other options—ranging from IUI to donor egg or adoption—may warrant discussion.

In cases where patients have frozen embryos remaining from the fresh IVF, we usually encourage them to attempt pregnancy with a frozen embryo transfer. Many patients who fail to conceive on a fresh IVF will conceive on the FET. The post-IVF consultation is one of the most useful discussions that a couple can have with the physician. It allows the couple to review all aspects of their care and to determine whether IVF represents the best approach to their particular situation. We firmly believe that this feedback is crucial to develop an appropriate plan of treatment for each couple.