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IVF cycle in surrogacy may fail due to certain reasons such as flawed embryos, hormonal problems, chromosomal abnormalities, lifestyle factors, implantation failures and ovary disorders. There are various ways to deal with a failed IVF cycle in Surrogacy like PGD, donor egg and a positive approach.
Let’s discuss in more detail what can be the reasons for IVF Failure in Surrogacy:
Surrogacy is an assisted reproduction-based procedure of IVF treatment where the intended performed for infertile parents who want to have a child who is genetically related parents engage a surrogate for the gestation and birth. Gestational surrogates carry the prepared embryo with the mother or donor egg and father or donor sperm. Surrogacy comprises a valid option for a variety of medical conditions or circumstances ranging from medical to social reasons.
Possible reasons for having a failed IVF cycle in surrogacy procedure can be:
a. Flawed Embryos: Flawed embryos takes place mostly due to the wrong number of chromosomes. An embryo transfer performed with the correct number of chromosomes can raise the success rates to as high as to 50 to 60 percent. The human body is very selective when it comes to allowing healthy embryos implant. If an abnormal embryo, also called as mosaics does implant, the pregnancy is failed either via a biochemical pregnancy or a miscarriage. (1) Flawed embryos do not implant into the uterus. When embryos are not able to grow enough it is more likely that they die out. Age has a significant role to play in the development of wrong chromosomes. In cases, where women have crossed the age of 40 years or more conception after embryo implantation is possible but usually ends up in miscarriage.
b. Sperm Quality: Semen analysis is conducted because in many cases sperm source is the cause for infertility. It happens when there is a defect with the DNA carried in the sperm. Semen quality is usually considered to be a proxy measure of fertility in men, and changes in semen quality can occur after exposure to toxic agents or from host factor effects like age. The evidence extracted from clinical studies suggests that age is one of the major factors associated with diminished semen volume, sperm motility and/or sperm morphology. (2) Abnormalities related to sperm count and morphology are considered to be a critical factor in male infertility can be azoospermia, low sperm count, abnormalities related to sperm motility and abnormal sperm structure and shape.
c. Body's Hormonal Response for IVF Surrogacy: Women having stronger hormonal balance are more likely to have a successful IVF cycle in comparison to the women whose hormonal systems are less healthy. Women with higher Follicle Stimulating Hormone (FSH) respond slowly to fertility medications. Also, with a higher age of female partner, fertility decreases and thus results in decreased egg production. Lower production of eggs can result in an improper screening of the eggs and potential implantation. The female reproductive system works by a balanced hormonal interaction between the hypothalamus, ovaries and anterior pituitary. Follicle-stimulating hormone and (FSH) and luteinizing hormone (LH) are considered important factors for ovulation and stimulation of secretion of estradiol and progesterone from the ovaries. Anti-Mullerian hormone (AMH) is an important marker of predicting the condition of ovarian reserve. The primary function of the ovary is to produce a mature and viable oocyte capable of fertilization, embryo development, and implantation. A delicate hormonal balance involved in regulating the reproductive organs enables and maintains fertility. These hormones control changes such as ovulation and thickening of the endometrium lining. Unexplained infertility can occur if this balance is disturbed. Therefore, hormones account to play an important role in the etiopathogenesis of unexplained infertility. (3)
d. Role of Ovaries in IVF Surrogacy: Sometimes, ovaries of a female do not respond strongly enough to produce multiple eggs. With higher age and fluctuating hormonal levels, egg production reduces in women. This can cause fewer eggs and fewer chances of fertilization. The response of ovaries in IVF treatment is important for stimulating prescribed medications in the body of a female patient. When ovaries do not respond, it becomes difficult for women to conceive. A cycle may get failed if the ovaries don’t respond optimally. The rate of an IVF cycle failure is approximately 5 to 10 percent and is age-dependent with older patients being canceled more often. Another possible complication during the stimulation process can be ovarian hyperstimulation. It is a condition that occurs when the ovaries become very enlarged and tender as an after effect of the stimulation medications used in IVF treatments. (4)
e. Chromosomal Abnormalities: Chromosomal abnormalities are a general cause of aborted fertility cycles whether in natural conception or IVF. Chromosomes play an important role in the conception both naturally or artificially. It is believed that with the advancement of age chromosomal abnormalities in the eggs of a woman increases in comparison to men. This can be the reason why women are said to grow older at a faster rate in comparison to men. Chromosomal abnormalities may take place as an accident when the egg or the sperm is formed or during the early developmental stages of the fetus. The age of the expectant mother and various environmental factors can play a significant role in the occurrence of genetic errors. Chromosomes of the fetus and to detect some, but not all, types of chromosomal abnormalities can be examined in prenatal screening and testing. (5)
f. Endometrial Lining: Endometrial lining receptivity also plays a vital role in failed embryo transfer. The intended mother or surrogate is usually given medication for preparation of the uterus and is monitored in the weeks prior to the transfer. A thin endometrial is encountered infrequently (2.4%) in IVF cycles. The etiology of thin endometrial plays a significant part in endometrial receptivity. Certain studies have shown that clinical pregnancy and live birth rates decline as the thickness of endometrial lining decreases below 8 mm in fresh IVF-ET and below 7 mm in frozen-thaw embryo transfer (ET) cycles. (6) It has been reported that the rate of miscarriage is said to be higher in patients where the endometrial-lining thickness was less than 7 mm. Research also showed that the clinical pregnancy rate, ongoing pregnancy rate, and implantation rate were reported highest in patients where the endometrial thickness was higher than 14 mm, and showed no difference in patients with an endometrial thickness between 8-14 mm. (7)
g. Implantation Failure: The cause for IVF failure can also occur when the process is in its concluding stage, during the implantation. The gametes may both seem to be healthy, but polyps, poor blood flow, cysts, and a thin uterine lining can lead to a failed implantation of the embryo. Recurring implantation failure is determined in the cases where embryos of good quality fail to implant following various In Vitro Fertilization (IVF) treatment cycles. Implantation failure occurs due to either maternal factors or embryonic causes. Maternal factors may include thrombophilia, uterine anatomic abnormalities, immunological factors, and non-receptive endometrium. Failure of implantation due to embryonic causes is related to either genetic abnormalities or other factors related to the embryo that impair its ability to develop in the uterus and to the implant. New methods of time-lapse imaging of embryos and assessment of their metabolic functions can improve the selection of embryos for transfer. (8)
Now, as the causes of the failure of IVF cycle are known, it is also equally important that you get to know regarding the ways to deal with IVF cycle failure in surrogacy and proceed with it accordingly.
- Preimplantation Genetic Diagnosis: Preimplantation Genetic Diagnosis is a reproductive technology which is used in cases related to repeated failures in the case of IVF Cycles in surrogacy. PGD is a part of an assisted reproductive technique that is used for couples who are at risk of having a child with significant genetic disorders. It involves the use of IVF in embryo creation which is selected based on their genotype and is transferred into the uterus with the aim of establishing a pregnancy with a fetus-free of the genetic disorders. PGD test is performed to screen and determine the genetic conditions, which have higher chances of passing on to the fetus. (9)
- Try more than one IVF cycle: It is always recommended that the couples need to make sure that they try at least thrice before giving up with the trials of the IVF cycle. According to research, it has been found that the IVF success chances improve with a number of cycles performed. The utilization of the extra embryos will help in increasing success rates and victoriously have their own babies.
- Sperm Fragmentation Test: If a couple has doubts about the presence of genetic abnormalities in the sperms then test like Sperm Fragmentation Test is advised for the male partner. This is an advanced test where the amount of damage to the chromosomes is found out which further helps a couple to proceed effectively in the right way. If the male’s sperm sample is not fit for IVF, then donor sperm can be used.
- Opting for donor egg: If the quality of eggs of the intended mother is not good, then obviously going with donor egg will be the best choice.
- Frozen Embryo Transfer procedure (FET): If the surrogate mother has a failed IVF cycle with fresh embryo transfer then she is advised to undergo Frozen Embryo Transfer in her next cycle. Chances of IVF are good with Frozen Embryo Transfer.
- Transferring more than one embryo: The infertility specialist will choose to transfer more than 2 embryos after discussing with the patient so that at least one embryo can be successfully implanted thus turning into a success. But it can also result in multiple pregnancies such as twins or triplets.
- Reanalyze the quality of eggs: If the PGD results show the genetic defect in the embryo then either the sperms or eggs are responsible for it. These gametes are tested individually for their quality before forming the embryo again. The infertility specialist checks the quality of the stored or freshly retrieved eggs, which boost the chances of positive pregnancy news.
SOURCES AND REFERENCES:
- ^ Embryos Are Abnormal After Pre-Implantation Genetic Screening Nyfertility.org, 27 March 2019
- ^ The Association of Age and Semen Quality in Healthy Men Academic.oup.com, 27 March 2019
- ^ jaypeejournals Jaypeejournals.com, 27 March 2019
- ^ Ovarian stimulation Uihc.org, 27 March 2019
- ^ CHROMOSOMAL ABNORMALITIES Ncbi.nlm.nih.gov, 27 March 2019
- ^ The impact of a thin endometrial lining on fresh and frozen-thaw IVF Outcomes Ncbi.nlm.nih.gov, 27 March 2019
- ^ Endometrial thickness affects the outcome of in vitro fertilization Ncbi.nlm.nih.gov, 27 March 2019
- ^ Assessment and treatment of repeated implantation failure (RIF) Ncbi.nlm.nih.gov, 27 March 2019
- ^ Psychological impact of preimplantation genetic diagnosis: a review of the literature Rbmojournal.com, 27 March 2019
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