Every couple who starts an IVF cycle should know that pregnancy and a live birth is not guaranteed. Although rare, here are some possible reasons your IVF cycle may be cancelled or fail to reach the embryo transfer.
- Your ovaries sometimes may give a poor response to drugs and the stimulation may be cancelled before collecting your eggs. If you are having a “natural” or “mini IVF” cycle, obtaining just one or only a few eggs are already expected.
- Mistimed trigger shot. Having your hCG injection at the wrong time triggers the release of the eggs before we collect them.
- Any illness before egg collection. If either partner faces problems such as high fever, it is wise to cancel the cycle and proceed after the problem is overcome.
- Sudden drop in estradiol levels. As eggs develop, levels of estradiol should also increase continuously through the stimulation. If there is an unexpected drop in estradiol level, there may be a problem with follicle development, and the cycle may be cancelled.
- Over response to the drugs. Drugs used to promote follicle growth can sometimes cause hyperstimulation since there are too many eggs produced and the risk of hyperstimulation syndrome can arise. Hyperstimulation syndrome is the exaggerated response to drugs and should be carefully watched. However, since we mostly use short antagonist protocol, we prefer to collect the eggs after giving a special triggering injection and freeze all the embryos and transfer later in the following cycles.
- High Progesterone hormone levels. Progesterone hormone normally rises after the ovulation and helps endometrium to accept the embryo. It should not be very high before egg collection since it may decrease the chance for implantation. For such cases, your doctor may recommend freezing all the embryos and transfer later.
- No eggs. Despite the presence of follicles during follow up, sometimes it may not be possible to obtain eggs from the follicles during the retrieval. Most common reason for this is premature rupture of the follicle. This is generally seen in women with advanced age. Besides, the follicles may contain no eggs which is called “empty follicle syndrome” and seen very rare independent of woman’s age.
- Fertilization failure. All of the eggs may not fertilize. This is actually also quite rare (approximately 2 % of the patients). Fertilization failure may be seen due to either abnormal eggs or sperms.
- Fertilized eggs may not divide and no embryo is formed. This is also very rare and due to abnormal eggs or sperms.
- Azoospermic (no sperms in the ejaculate sample) male may not give spermatozoa to needle aspiration or even open micro TESE ( Testicular Sperm Extraction ). In this case, the treatment is cancelled prior to egg retrieval.
- No normal embryos may be found if PGS (Preimplantation Genetic Screening) is performed. In this case embryo transfer is not performed.
Although cancelling a treatment cycle can be quite disappointing for both the couple and your physician, it is sometimes a necessary course of action. Cancelling your cycle may help you avoid more serious complications and also prevents wasting your time and money, ensure a best chance of success in the future.
Having a cycle cancelled does not mean that following cycles will have the same unfortunate fate. A detailed evaluation of your condition by your physician will improve the possibility of success in the following cycles.
Please do not forget that there are thousands of couples who hold their babies after repeated attempts.
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