In fertility treatment, success isn’t guaranteed.
As a fertility specialist with years of experience, I understand the daunting journey many couples face when striving to conceive, especially those dealing with the heartache of recurrent miscarriages or unsuccessful embryo transfers.
However, I firmly believe that strategic timing in treatment can significantly enhance a patient’s chance of conceiving,
I usually explain this to my patients during consultations: for an in vitro fertilisation (IVF) process to succeed, two crucial factors are necessary.
Firstly, we require a ‘chromosomally normal’ embryo, meaning the number of chromosomes is perfectly normal.
Any deviation from this norm could result in procedural failure or, worse, a miscarriage.
As women age, the likelihood of miscarriage rises. It’s a well-known fact that as women grow older, they begin to lose their best eggs.
Consequently, when older women conceive, there’s a higher risk of embryos being abnormal.
An example is Down syndrome, which significantly increases in incidence among women over 40. It can affect 1 in every 100 babies born to mothers in this age bracket.
Cause Of Unsuccessful Outcome
I often find that chromosome abnormality is a primary cause of miscarriages among women.
Additionally, I have observed that women may experience miscarriages due to blood disorders affecting the immune system, such as anti-phospholipid syndrome, which can lead to abnormal clot formation behind the placenta.
Moreover, I have noticed that women with underlying health conditions like uncontrolled diabetes or thyroid problems are at higher risk of miscarriages. Structural abnormalities of the womb can also contribute to miscarriages.
Ideally, the womb should have a normal shape and dimension with a smooth inner lining.
Any deviation from this, such as abnormal shape or the presence of polyps or uterine fibroids causing irregularity in the womb lining, can also increase the risk of miscarriage.
Strategise Your Timing For A Better Success Rate
The first step for me is to assess why a woman may be experiencing difficulty conceiving.
Once I have identified the underlying issues, I tailor the treatment plan accordingly, aiming to maximise the chances of conception for each patient.
We focus on four main areas: conducting a sperm test, performing an ultrasound scan of the womb and ovaries, administering an X-ray called hysterosalpingogram to check for blocked fallopian tubes, and conducting hormonal blood tests.
Any problems or abnormalities found are addressed before proceeding with further treatment.
Here is an example of the various treatment options. Firstly, I advise couples on the best timing for intercourse, typically during the woman’s most fertile period.
Additionally, I may prescribe hormonal medications to stimulate egg production in women and the patient is then scanned to determine the best time for intercourse to increase the chances of conception.
Another treatment option is intrauterine insemination, where we process the husband’s sperm and inject it directly into the womb. This procedure can significantly increase the success rate of conception by 15 per cent to 20 per cent.
Understanding Your Options
After the initial steps, we move on to IVF, commonly known as the ‘test tube baby’ method. In this procedure, I administer a series of injections to the woman over 10 days, followed by extracting her eggs while under anaesthesia.
Subsequently, I directly inject sperm into the eggs to ensure fertilisation. After five days, we transfer the resulting embryo into the woman’s womb.
If the standard IVF process doesn’t yield success, I present patients with two alternative options.
First is Pre-implantation Genetic Testing (PGT) where we determine which are the best embryos to be transferred.
A small amount of cells are extracted from each embryo for chromosome analysis which will help determine if the embryos are healthy.
The other option is Endometrial Receptivity Analysis (ERA/MIRA). This method will help determine the best time frame for implantation of the embryos in women.
Basically, PGT will help determine the best embryos while ERA/MIRA will signal the best time to transfer these embryos. Studies have shown the combination of these two procedures can increase conception rates by up to 80 per cent.
Other tests and procedures, like Endometrial Microbiome Metagenomics Analysis (EMMA), assess the presence of beneficial bacteria in the womb lining to facilitate conception.
For patients with imbalanced bacterial flora, probiotics may be prescribed. Additionally, Analysis of Infectious Chronic Endometritis (ALICE) addresses chronic infections of the womb lining, correcting any bacterial imbalance with antibiotics.
I have witnessed success with these treatment methods in my practice. For instance, I recently helped a woman in her 40s who had experienced repeated miscarriages despite having healthy embryos.
After conducting more detailed tests, we identified the optimal transfer window. As a result, she successfully gave birth to healthy twins.
Avoiding Genetic Problems
According to my recommendations, these treatment options are suitable for women who have experienced recurrent transfer failures despite transferring healthy embryos, as well as those who have suffered from multiple miscarriages due to abnormal foetuses.
Additionally, individuals with a family history of genetic disorders, such as cystic fibrosis or thalassemia, may opt for these treatments to prevent passing on hereditary conditions to their children.
This allows patients to choose the gender of their offspring based on genetic testing, especially when they wish to avoid passing on gender-specific genetic conditions.
When it comes to infertility, timely action is paramount for maximising success rates. By proactively addressing questions and seeking guidance, individuals undergoing IVF treatment can enhance their chances of achieving their desired outcome.
Remember, time is of the essence in this journey towards parenthood. Therefore, prioritising early intervention and informed decision-making can pave the way for a more hopeful and successful IVF experience.
Dr Navdeep Singh Pannu, a fertility specialist, currently serves as the medical director at TMC Fertility and Women’s Specialist Centre in Puchong. With over a decade of experience, he has assisted couples of all ages and from various parts of the world in building the families they have always wanted. Additionally, he is a consultant obstetrician, gynaecologist, and laparoscopic surgeon.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of Ova.
