Couples who try in vitro fertilization to have a child may experience disappointment when pregnancy is not achieved and leave the treatment completely. However, in recurrent IVF failures, it is possible to have a baby by determining the factors that cause it, advanced examination and modern applications.
Recurrent IVF failure is the inability to achieve pregnancy after 3 consecutive IVF treatments. The most common problem encountered in the failure to achieve pregnancy is the inability to develop a good embryo when there is no problem in the couples. It is not possible for every patient to give the same predictable response to standard protocols. For this reason, approaches to improve egg quality with protocol and drug changes or supportive treatments provide better embryos.
In order for the pregnancy rates to be high in the treatments, the thickness of the uterine membrane should be at a certain rate and regularly. In recurrent IVF failures, the uterine membrane should be examined in detail. If necessary, medicated uterine film should be taken again, and if possible, the uterine membrane should be evaluated with 3D ultrasound and hysteroscopy. If fibroids, polyps or adhesions on the uterine lining are detected in the examinations, they must be treated. In addition, if fluid collection is seen in the oviducts on the medicated uterine film or on ultrasound, this oviduct should be removed or ligated before a new trial.
Many methods can be used in recurrent IVF failures related to the uterus. Among these, it can be shown to increase the adhesion by biopsying the uterine membrane before treatment and to increase the adhesion by washing the uterine membrane with some stimulating molecules before transfer. Unfortunately, it has not been clearly demonstrated in scientific studies that these applications have proven to increase success. Considering the factors related to the embryo, in recurrent IVF failures;
On the 5th day, embryo transfer, embryo culture and thinning of the thick part of the embryo are applied. In these applications for embryos, the effectiveness of other methods has not been fully proven except to create embryos on the 5th day.
Another issue that needs to be examined in couples with recurrent IVF failure is genetic examinations to be examined from the blood of the couples. Various genetic abnormalities that may occur in couples can prevent the attachment of the developing embryo. In such cases, genetic examination of embryos and placing healthy embryos in the uterus are used.
In fact, apart from genetic examinations, if most problems can be diagnosed and treated in the first step of IVF treatment, the disappointment of patients after unsuccessful attempts will be reduced to a very low level.
EMBRYO FREEZE
Embryo Freezing Process in IVF
Thanks to the embryo freezing and thawing method, which has been applied in IVF Laboratories for 20-25 years, and new techniques developed in recent years, it is possible to achieve a much higher rate of pregnancies. The reason for this is that there is a chance to transfer several times (in vitro fertilization trial) from the eggs collected once for the couple
with the freezing technique, thus increasing the total pregnancy rate. The first frozen embryo baby in the world was born in 1984. Embryos can be frozen at all developmental stages. Embryos are mixed with a protective liquid and placed in glass tubes and stored frozen at -196 degrees in liquid nitrogen. When frozen embryos are to be thawed, they are removed from liquid nitrogen, thawed at room temperature, separated from the protective liquid, taken into a special culture medium and placed in the incubator. Embryos that look good on the same day can be transferred. In our center, we freeze mostly day 3 and day 5 embryos with the vitrification method. After the 3rd day embryos are thawed, sometimes the same day or sometimes (depending on the characteristics of the patient) embryos that wait 2 days and go to the 5th day can be transferred.
What are the advantages of embryo freezing?
Depending on the patient’s condition, a maximum of 1 or 2 embryos can be transferred in the fresh cycle. If a large number of embryos have formed in the patient, suitable ones are frozen for further use. The probability of survival of embryos after freezing and thawing varies depending on embryo quality,
freezing stage, freezing technique, genetic factors and embryo freezing success rates of the center. The probability of survival of frozen embryos after thawing is around 90% in our center. The chance of pregnancy after the transfer with embryos obtained in this way varies depending on the age of the woman.
In which cases embryo freezing is performed:
– If quality embryos remain after embryo transfer
– If bleeding occurs during treatment
– Depending on the drugs used, all embryos can be frozen, especially in case of excessive ovarian stimulation (OHSS) in patients with polycystic ovary syndrome.
– In case it is determined that enough of the endometrium tissue surrounding the uterus is not suitable for transfer
– In case it is determined that enough of the endometrium tissue surrounding the uterus is not suitable for transfer
– Before cancer treatments that require chemotherapy or radiotherapy
Thawing and transferring frozen embryos provides couples with a chance of almost a fresh trial pregnancy with much less expense. Moreover, there is no need for long-term drug use, egg collection and microinjection processes.
The purpose of preparing the patient for transfer for frozen embryos is to prepare the inner lining of the uterus and reach sufficient thickness. Different methods can be used for this. In drug-free application, the patient’s ovulation is followed up and the inner lining of the uterus is expected to thicken in its own way. By determining the day of ovulation, transfer planning is made according to which day the embryo is frozen. It is also important to examine blood hormone levels (E2, LH, Progesterone) during this follow-up.
Prepared transfer months are generally preferred for those who have irregular menstruation and for the advanced age group. With estrogen tapes or pills, the uterine lining thickness is followed by ultrasound until it reaches 7-8 mm, and then the transfer is planned by adding other hormone drugs to the treatment. Pregnancy success is the same with both methods.
Studies have shown that there is no increased risk of anomaly in babies born this way. Scientific studies have shown that frozen embryos give a healthy pregnancy chance even when thawed after a very long time, such as 10-15 years. However, in accordance with the relevant regulation of the Ministry of Health in our country, embryos can be stored for a maximum of 5 years. Legally, spouses must apply with a petition in order to continue the storage of embryos every year. If no application is made at the end of one year, one month is expected and the embryos are legally destroyed.
