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Treating Recurrent IVF Failure & Recurrent Miscarriage

If you’ve been battling to conceive, suffered recurrent IVF failure or had repeated miscarriages, you will know just how overwhelming and emotionally draining these experiences can be. Women often say they feel vulnerable and frustrated by a lack of knowledge about why they are failing to conceive or carry a successful pregnancy to term.

It takes a lot of courage (not to mention funds) to undergo IVF cycles and produce embryos successfully, only to see them fail to implant. However, there have actually been many cases of couples who were told they should give up on IVF conception, but were able to achieve a successful pregnancy through investigation and treatment with the right fertility specialists. In order to get to the root of any medical issues involved, special tests may be carried out by fertility experts to isolate specific difficulties.

These diagnostic tests can be broadly grouped into four categories:

A: Immune Testing:
Conventional medicine holds that IVF failure and miscarriage are the result of hormonal problems, abnormalities of the uterus, genetically defective embryos or ageing eggs. But many fertility doctors increasingly believe they may be caused by a patient’s immune system going into overdrive. They believe certain so-called ‘killer’ cells which are designed to help prevent the body from developing cancer may over-populate the uterus or exist at relatively high levels within the blood. These cells then go overboard, killing the embryo or interfering with the endocrine system that produces the hormones essential for pregnancy.

Fertility experts can carry out tests to check the quality of your immune system and any clotting factors (thrombophilia). These include testing for: Antibodies, Natural Killer Cell Assay, TH1/TH2 Intracellular Cytokine Ratio, Gene Mutation of Factor II, Factor V and MTHFR, Leukocyte Antibody Detection (LAD) or Paternal Leukocyte Antibodies (PLA) and DQa genes.

Once the problem has been identified, the right specialist can provide relevant supportive immune therapy: Steroids, Clexane, IVIg, Intralipids and Lymphocyte Immune Therapy (LIT).

More information on Immune Testing is available here.

B. Infection Screening:
Infections, particularly Chlamydia, mycoplasma and ureaplasma can last and recur for years. These infections make it unsuitable for the embryos to implant or the pregnancy to continue. They can also agitate the immune system and make it over-reactive. If the infection is enclosed in blocked tubes, they can cause what’s known as hydrosalpinx – meaning that the tube contains potentially infectious fluid. This reduces the chance of IVF success by about 50%.

However, expert testing on menstrual blood, vaginal swabs and semen samples can uncover any such hidden infections which can then be treated – either with antibiotics or occasionally, with a procedure.

C. Assessment of Uterine Cavity:
Sometimes implantation failure or miscarriage can happen because of an abnormality in the uterine cavity e.g. polyps, adhesions, scar tissue or possibly even a uterine septum. Fertility specialists can explore the uterine cavity by saline hysterography (a type of X-ray) and, if any such abnormalities are found, perform a hysteroscopy (remove problem tissue with a hysteroscope) for its treatment.

D. Karyotyping:
Either you or your partner may need testing for underlying chromosomal rearrangement problems.

Sometimes one part of a single chromosome gets detached and then attaches to another chromosome. This doesn’t cause physical abnormality in the parent because the set of total chromosomes (DNA) is actually complete. The mother cells producing the eggs and sperm divide into two equal halves to produce the eggs and sperm with half the number of the chromosomes. When the egg is fertilised by the sperm to form the embryo, twice the number of chromosomes will be attained. If the mother cell has a chromosomal rearrangement problem there will be an unequal split of DNA material. The sperm or the egg will either miss or carry an extra part of a chromosome and the resulting embryo will therefore not be chromosomally normal. It then follows that the embryo either fails to implant or results in a miscarriage.

If this problem is identified beforehand, specialists can test the embryos and select only the suitable ones for transfer.

There are no guarantees these medical interventions will improve your chances of a successful pregnancy. But a personal treatment plan with the right fertility doctor can substantially increase the likelihood. In fact, many women who were advised to give up have gone on, with the right treatment, to carry their own babies to term.

Related Video: Treating Recurrent IVF Failure & Recurrent Miscarriage

We thank Dr Gorgy from The Fertility and Gynaecology Academy, for providing specialist knowledge for this article.

The Fertility & Gynaecology Academy is an established Assisted Conception (IVF) unit in Central London that offers infertility treatments. Founded in 2004 by two of the UK’s most prominent fertility and gynaecology specialists Dr Gorgy and Dr Eskander, it is also one of the few IVF clinics in the UK that offers reproductive immunology treatments. The clinic enjoys a consistently high success rate, especially for women with complex fertility problems.

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