Dr. Ioannis Toliopoulos, Ph.D., Molecular Biologist, Physiologist, Immunologist in Reproductive Medicine
Dr. Spyridon Papageorgiou, Gynecologist, Obstetrician, Specialized in infertility
The issue with the IVFs trials especially when they fail after many attempts are multidimensional. The anxiety of the couple to hold their baby in their arms has led sometimes to fast decisions, which result in IVF failure and a negative impact even on the couple's health. That's why this article is intended for couples that go under IVF trials and gives the ways that they have to know before they can try for an embryo transfer with higher chances to succeed in pregnancy. If the couple doesn't follow the instructions below, the result will be to be prosecuted more and more and they will spend much money for many in vitro fertilization trials.
The 10 ways that the couple must follow are the following:
- The exclusion that the husband's sperm is responsible for infertility by testing sperm DNA fragmentation or DFI, which is very important because the usual sperm analysis is not enough to diagnose the genetic quality of the male's genetic material. This means that DNA is fragmented into different sections because of smoking, alcohol, electromagnetism, oxidative stress, and other factors.
- Checking the quality and quantity of women's ovaries because if the quality of eggs is poor, then the result after a successful pregnancy would be RSA. One diagnostic marker is the hormone AMH (antimullerian hormone), which shows the fertility capability of women in terms of a number of ovaries. However, this marker is not adequate by itself to show that a woman has quality and quantity in ovaries.
- Inhibin B is an additional test and is the hormone that shows us the quality of the ovaries. So, with these two tests, women know for sure whether they are fertile. This specific test is performed ONLY the 3rd day of the cycle.
- The thickness of the endometrium must be examined carefully from the appropriate gynecologist and the women must be consulted in a suitable way, which is the higher thickness in order to have more chances for the embryo transfer to be successful. Statistically, the thicker the endometrium, the more chances for a successful pregnancy.
- A very careful ultrasound from a specialized gynecologist who can see details in the anatomy of the woman's reproductive system and can diagnose whether there is any anatomical problem so natural pregnancy can be achieved.
- Immunological targeted testing including the number of Natural Killer Cells (NK cells) and the endometrial NK cells, which usually block pregnancy or the embryo transfer and is the MAIN cause for IVF failure most of the times.
- The activity of NK cells blocks pregnancy because their receptors attack the embryo and lead it to apoptosis and don't allow it to be implanted because they recognize it as an invader to the body. By this way, again IVF fails. This test is totally different from test number 6 and is very important for the stability of the pregnancy especially until the 3rd month of the gestation.
- Embryotoxicity (ETA) is a very important test especially for women that fail in their IVF trials. It has been proposed that positive and negative embryotoxic factors provide the basis for a new classification of idiopathic recurrent pregnancy loss and in vitro fertilization (IVF) failure. The prevalence of embryotoxic activity among women experiencing recurrent pregnancy loss is 10% to 15% and among IVF failures is 20% to 25%. Embryotoxic factors have also been reported in women experiencing unexplained infertility and infertility associated with endometriosis.
- The test platelet-leukocyte aggregates is a new test for identification of thrombotic events in RSAs and failed IVFs. Increased platelet-leucocyte aggregate has been reported in women that had RSAs or failed IVFs because of the thrombotic events that were diagnosed afterward. This test can help not only for diagnostic purposes but also to guide the physicians in order to perform the appropriate therapy with low molecular heparin for successful women's pregnancy. This test can be performed in combination with the genetic thrombophilia panel testing. The methodology used for this test is flow cytometry and a green top tube is needed to run the test. The classical thrombophilia molecular tests are not enough to guide the woman for targeted and individualized therapy.
- Blocking factors in a specific test for the couple, which clears whether there is histocompatibility in the couple's immune system. This is only one test and does not require many tests as it was known up today and it was very costly. Blocking factors are not detected in most women with recurrent pregnancy losses (RPL) or unexplained imminent abortions (IA) or failed IVFs. The good news if a couple is positive in blocking factors is that there is a therapy that lasts one year and gives the chance the couple for successive pregnancy.
All the above ways increase the pregnancy success rates after IVF trials because these specific diagnostic tests and the targeted individualized therapies create higher chances for embryo transfer to be successful and the statistical analysis informs us for a rate over 80% of successful pregnancies. However, it has to be clarified that the investigation, diagnosis, evaluation, and therapy MUST be performed by an expert and very well trained scientists in the field of reproductive medicine, so the couple can finally have their healthy baby with the lowest cost.