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How does Hysteroscopy help after failed IVF cycles?

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Infertility Specialist
Practicing since : 2002
Answered : 673 Questions
I would like to know about my sister - She is not able to concieve because her tubes are blocked. Doc suggested IVF - Her 2 cycles failed .First Cycle failure reason was - Wall thickness that was 15 mm . Second Cycle failure reason - Body is not accepting where in this time wall thickness was perfect 10 mm - 5 embryos of good quality were tranferred . Doc suggested third try - He is saying that he will do after hysteroscopy . Now my question is how hysteroscopy can help in this ? Do you think when 2 cycle got failed there is chance that after hysteroscopy she can concieve . Also , Should she go for Donor eggs this time ? Do you think that chances are there if we go for donor eggs and hystroscopy then own eggs . Also how the chances can be increased to get positive result in IVF . Her age is 37 years .Docter is saying that LIT would also help . so doyou think that it would or he is just making money . What are the reasons that body is not accepting . Doc says that 6 eggs were retrieved and out of that 5 got fertilised so thats the good sign , thats y he is saying try from your own eggs than donor but why is he not thinking about the chance that if she will go for donor eggs chances are more .
Posted Tue, 11 Feb 2014 in Infertility Problem
Answered by Dr. Dattaprasad 57 minutes later
Brief Answer: Hysteroscopy should be done. Detailed Answer: Hi, Welcome to XXXXXXX At the age of 37, even with good number eggs/embryos, chance of pregnancy is around 30% -35% per cycle. It depends further in which center you are undergoing IVF & that center's baseline & age specific success rate. Regarding hysteroscopy: Hysteroscopy is must after two failed IVF cycles. There are many small abnormalities (polyps/synechiae) that are not visible on ultrasound & can only be seen & corrected through hysteroscopy. Second thing, even if no abnormality is detected, hysteroscopy done before IVF, improves success rate. Regarding need for donor eggs; What was quality of embryos she got during both cycles? If quality was good (Most of centers label good quality embryos as Grade I), she can go ahead with one more cycle with own eggs. Although its true that donor eggs will give better chance of pregnancy, own eggs will give chance to conceive with own genetic material & some people may prefer that. Upto 4th cycle of IVF, gives constant good chance of pregnancy & thereafter success rate decreases unless there was some obvious reason for failure. As she had reason for failure in first cycle (Thick endometrium), she should definitely go ahead with one more cycle at least. Reasons for body not accepting: Its mostly embryo-endometrium interaction. In first cycle, obvious reason was endometrium. But even without any obvious reason, success rate of IVF is not 100%. There are many events occurring at molecular level which we are not knowing. That's why we don't give 100% success rate in IVF. Regarding LIT therapy, its role in improving IVF success rate is not proven & I do not advocate it for my patient. One of the ways to improve success is to do blastocyst culture & transfer (Growing embryo for 5 days outside body). But at the age of 37, its doubtful whether embryos will grow till 5 days unless IVF lab & embryo quality is very good. So summarizing plan of management, she can go for hysteroscopy followed by one cycle of IVF with one eggs if embryo quality during past two cycles was good. If embryo quality was not good, she can go for hysteroscopy followed by IVF with donor eggs. You can consult your doctor regarding need for donor eggs. Let me know if you have other concerns. Regards.
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Follow-up: How does Hysteroscopy help after failed IVF cycles? 17 hours later
Many thanks for the detailed reply . You have menioned that reason for not accepting is mostly embro endometrium interaction . Please can you specify this in detail . How can this be improved before IVF Cycle . Can she do something herself to improve this ? What do you recommend ? Can this be cured thru hystroscopy ? Would excercise help? Also , Please tell how many cycles one can be try? Is there ny end to it ?? What are the side effects ? Also if she opt for donor eggs than child will resemble whom & genes ? So if she get the hystroscopy done & go for donor eggs then that means that chances are more positive than doing the IVF with own eggs ? One more doubt - if 2 cycles got failed , Should she give some gap or within 2-3 months only she should go for the third one ? What is advisable ?? So she should not start LIT as her docter said that she should take lit after every 2 weeks .
Answered by Dr. Dattaprasad 2 hours later
Brief Answer: Donor eggs, better chance. Detailed Answer: Hi, Welcome back. Here is my reply to your queries. 1. Embryo endometrium interaction are molecular events occurring at the time of implantation (embryos attachment to uterus which generally occurs between 7-10days after egg pickup) which are not under doctor's control & so can't be changed. Only factors definitely known to improve implantation are: blastocyst transfer, correction of cavity factors by hysteroscopy before IVF & treatment of hydrosalpinx (fluid filled tubes) (if seen on ultrasound scan). 2. Hysteroscopy can find hidden defects like polyp/synechiae, treatment of which can improve success rate. 3. Exercise improves general well-being & can boost morale & reduce stress & might help indirectly. 4. You can try as many cycles as you want. I have seen pregnancies occurring in 10th/12th IVF cycle. Only limiting factor is cost. But after 4th IVF cycle, chance of becoming pregnant reduces (but not to zero percent). So you can try at least till 4th cycle with decent chance of success. 5. There are practically no long term side effects. Short term side effects like risk of bleeding/injury to other organs during egg retrieval, hyperstimulation syndrome are same with each cycle. 6. Normally doctors select donors resembling patient (wife). Though wife's genes won't passed to baby in case of conception with donor eggs, child should resemble parents when donor is well selected (wife's appearance). 7. Yes, chances will be better if she goes for hysteroscopy followed by IVF with donor eggs (compared with own eggs at the age of 37). But I repeat, its the women's preference to opt for donor eggs. I don't know how much donor eggs are acceptable to her. 8. A gap is necessary only for physical OR emotional recuperation. If she finds herself fit, she can go for next cycle even with less gap. 9. I already told that role of LIT therapy in improving IVF success rate is not proven & I do not advocate it for my patients. Hope this helps you. Let me know if you have other concerns. Regards.
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Follow-up: How does Hysteroscopy help after failed IVF cycles? 47 minutes later
Thanks so much . What is Surrogacy ? Is it very expensive ?
Answered by Dr. Dattaprasad 28 minutes later
Brief Answer: Yes. Detailed Answer: Hi, Welcome back. In surrogacy embryos are placed into uterus of other (hired) woman who is called as surrogate. If you can find such a woman who can carry pregnancy for 9 months for you in your relatives/friends/known people, surrogacy is not expensive. If you can't find such a woman, you will need to hire one from agency/through newspaper ads. Such hired woman can ask compensation which can be from 2-3 lacs to 6-7lacs. Apart from this amount, you will need to pay for IVF procedure, cost of all medicines/hospitalization etc for surrogate. Till the baby is born, expense may well go upto/above 8-10lacs. Surrogate is need for those patients who do not have uterus (either since birth OR removed surgically for some problem) OR those patients whose uterus/endometrium is so bad as to be incapable of carrying pregnancy OR those who have high risk if they become pregnant (like heart disease). You should consider this as last option, as its expensive & not needed for her right now. Hope this helps you. Let me know if you have other concerns. Regards.
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