Dr. Walid Saleh from CRE (previously SIRM-Dallas) Discusses Potential Reasons for IVF Cycle Failure

There is nothing more frustrating an IVF cycle fail and getting no explanation.

Here are some important factors that we always consider when analyzing an unsuccessful IVF cycle at our Dallas fertility clinic:

    1. What was the quality of the embryos on and before day 3? Egg issues will generally manifest themselves before day 3.
    2. Was a day 5 Embryo Transfer attempted? Embryos that survive 5 days are usually better quality.
    3. Was there a hidden sperm factor? We can use the Sperm DNA Integrity Assay (SDIA) to test. Sperm DNA kicks in after day 3 post-fertilization. This can throw off good looking day-3 embryos. If the sperm is abnormal, was ICSI done to maximize fertilization?
    4. Uterine scar tissue – what was the result of Fluid Ultrasound or office hysteroscopy?
    5. Immune issues – is there a history of other immune issues like endometriosis or hypothyroidism? Were you tested for activated Natural Killer Cells (NKa) and Antiphospholipid Antibodies (APLA) in a reliable laboratory?
    6. Was the Embryo Transfer smooth or difficult?
    7. What was the thickness of the uterine lining at ET (>9mm is best)
    8. What stimulation protocol was used? Too early or too high an exposure of LH (menopur) can affect egg quality.
    9. If the ovaries responded too fast (severe ovarian hyperstimulation), was the coasting method appropriate?
    10. Are your periods irregular? If so, was fasting insulin tested – metformin is useful only if fasting insulin is elevated
    11. If the embryos looked good, were they genetically normal? Was PGD/CGH testing done?

This is but a brief list of factors that I examine with my patients at our Dallas IVF clinic. Your doctor can give you more information on each of these factors as they apply to your situation. Fortunately, with a careful review, most issues can be resolved and a successful outcome can be attained in most couples.

Dr. Walid Saleh is a physician with CRE (previously SIRM-Dallas). Read other articles from Dr. Saleh on the ABC of infertility by clicking HERE.