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IVF failure and what next

The aim of IVF treatment is to produce a healthy baby and anything short of this may be deemed a failure of treatment. Failure in the first cycle does not, of course, rule out the chances of success in repeated cycles.

In fact, the success rate per cycle in the first three cycles of treatment are approximately the same. Although the chances of a live birth do fall after three unsuccessful cycles, many children have been born from succeeding treatments. Continuing beyond three cycles often depends on the outcome of these cycles, whether the chances of success are still considered reasonable and, importantly, the cost.

A first failed cycle provides information which may aid in the correction of one or more factors to improve the chances in succeeding cycles. For example, if eggs were obtained but no fertilization was achieved by standard IVF then ICSI (intra-cytoplasmatic sperm injection) can be employed. This entails the selection of a sperm and its injection directly into the egg rather than just mixing the sperm with the egg. This is the recommended treatment for severe problems with the sperm but may also be used for any case of failed fertilization. When a low number of eggs are produced, a change in the protocol for stimulation of the ovaries may make a difference.

The commonest cause of IVF failure is a relatively high female age and success rates start falling after the age of 36 and alarming so from the age of 40. Not only does the number of eggs available decline rapidly with increasing age but, importantly, the quality of the eggs dips similarly, deceasing the chances of success.

This is not, of course, a correctable factor. This is emphasized by the fact that when eggs donated from a younger woman are employed (egg donation), success rates soar considerably. If age is considered to be the cause of the failure then egg donation is a very successful form of treatment.

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