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Patient Wonders Why Embryos Were 'Rejected' during IVF


a blog by David Kreiner, M.D., F.A.C.O.G., East Coast Fertility, January 4, 2011

Dear Fertility Doc:

Two months ago I had my first IVF cycle, and it did not work (IVF implantation failure). I was wondering what common reasons there are a body would reject the two embryos that seemed to look good on the third day?

A few years ago I had a healthy child that came naturally without even trying. In the past two years, I’ve had an ectopic pregnancy, resulting in removing a tube, as well as a miscarriage. It’s hard to understand why it was so easy to get pregnant naturally a few years back and why everything we have done since that time has not worked. Also, if a fresh embryo transfer didn’t work on day three, would you recommend trying a frozen transfer or a fresh transfer again.

Still Not Pregnant

Dear Still Not Pregnant:

I often hear patients refer to a failed embryo transfer as an embryo rejection. I suppose it appears to make sense, as the embryos that are being transferred appear completely normal. The disconnect between what appears to make sense and the reality of the procedure of IVF is that the creation of life is an enormously complex process truly beyond the level of human understanding.

Great strides have been made in the process, resulting in pregnancy rates exceeding 60 percent for some groups. However, the apparent quality and grade of an embryo predicts the likelihood of a resulting pregnancy, but it is far from guaranteeing a pregnancy. New tests for the viability of an embryo are being developed, such as metabolomics and proteinomics. These assess an embryo by analyzing products of an embryo in culture. They will further the likelihood of achieving a pregnancy from a transferred embryo.

Remember, that even though an embryo may be otherwise viable, it may still be abnormal genetically, which will diminish pregnancy rates and usually result in miscarriage when implantation does occur. The likelihood of a genetically abnormal embryo developing increases, especially as the age of the woman increases, as well as with severely decreased sperm counts in the male.

The decision to go forward after a failed fresh transfer with a frozen transfer of sister embryos or a new fresh transfer should be individualized based on the quality and grade of the frozen embryos, the age of the woman, her
insurance coverage and her tolerance for the stimulation and retrieval, as well as her motivation and patience. I recommend you have this conversation with your physician who can advise you better about your specific situation.

I wish you the best of luck!

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