Failure Of Treatment

1 Failure of Treatment

No assisted conception clinic can possibly guarantee that you will conceive and successfully deliver a baby. At best, conception rates are around 30% per cycle which is about the same as natural conception. For some couples, especially where the woman is older than 35 years, conception rates are much lower than this.

Just as with natural conception, several attempts at assisted conception may be required before a pregnancy is successful. It is therefore safest to assume before starting treatment that more than one attempt will be required.

Infertility treatment can be demanding in many ways. It can stress you and your partner physically, emotionally and financially. It is therefore best to be well prepared for these eventualities. The more information you have access to and the more knowledgeable you become about infertility, the better the chances of coping with these stresses.

Despite this, the realisation of treatment failure is quite understandably devastating for most people. Most specialist clinics should offer counselling before, during and after your treatment. It is highly recommended that you make full use of any counselling available especially if your treatment is unsuccessful. Thereafter, most specialists would suggest that you defer any further treatment for about 2 months to recover from the psychological and physical effects of the failed treatment cycle.

Before resuming treatment, a full discussion with your specialist is vital to understand any potential problems, the cause of treatment failure (if known) and which method of assisted conception should be tried next.

A specific point to note is that when couples try to conceive naturally, many will have miscarriages that are unrecognised as such. This is because many miscarriages occur very early on in pregnancy before a woman is even aware she has conceived and carries out a pregnancy test. Menstruation may be delayed for a few days and then begins after the miscarriage. Women may simply see this as a late period. But when having infertility treatment, women are generally fully aware of what is happening. There is therefore no chance of missing a miscarriage and every miscarriage is therefore recognised. This gives the false impression of a higher failure rate when in fact, it may be very similar to nature.

Why Does Treatment Fail?

Treatment can fail at any of the many complex steps that are required for conception. In IVF for example, treatment may fail due to;

a failure of the ovaries to respond to stimulation to produce eggs,
the ovaries becoming hyper-stimulated because of infertility drugs. This may cause OHSS,
a lack of eggs: empty egg sacs may form under stimulation from infertility drugs,
a failure to fertilise eggs after successful collection. This may be due to a problem with the eggs or sperm,
fertilised embryos failing to mature. No transfer into the womb can then take place,
transferred embryos into the womb fail to implant or develop inside the womb.

Failure of embryos to develop after transfer into the womb is the commonest cause of infertility treatment failure. There may be many reasons for this including;

a developmental problem with the egg before fertilisation,

failure of the embryo to develop properly before transfer. This may not be obvious before transfer,

chromosomal disorders: though outwardly, many embryos may look healthy, they may contain defective chromosomes. These embryos have a much reduced chance of success. Please read the page entitled "Genetic Testing" for further details regarding this. A new test called PGS may help to solve such problems in the future,

poor blood flow to the womb: this means that even if your embryos are healthy, they stand a lesser chance of developing into a healthy baby as the womb is unable to sustain a pregnancy,

immunological problems: it has been recently suggested that several immunological disorders in the woman may be the reason for failure to conceive. This area is still open to debate but some clinics may be able to offer highly specialised tests to determine if this is the case,

unexplained reasons: despite all the investigations that are available, it remains unclear in many cases why implantation and pregnancies fail.

What Should You Do Next?

This is an extremely difficult question to answer as the correct answer really varies from couple to couple and individual to individual. You should understand the options available to you and make an informed decision on what to do next. Your options include;

repeat the whole treatment cycle again, after a "rest" of around 2 months,
use any eggs or embryos you have left from previous cycles so as to reduce the number of steps needed,
consider the use of donor sperm, eggs or embryos if it becomes clear that there is a problem with your own,
if the specialist considers it unlikely that you will conceive, then you need to re-evaluate the whole process of conception and what your options might be. This is an extremely difficult process.

Coming to terms with the fact that you may never conceive is a hugely traumatic experience.

What Happens Then?

There are several options worth considering then. These include;

surrogacy: if you cannot fall pregnant yourself, you may wish to find a surrogate mother who may be willing to carry your unborn child to term. This is a highly controversial subject and there may be many legal barriers to negotiate before this is possible,

fostering: this may be a realistic option and one which can help many unfortunate children. It can be a highly rewarding experience,

adoption: this again can be highly rewarding as you become the legal guardian of a child. You will then become the main parental figure(s) in a child's life despite the child not being biologically your own.

If none of these options is possible or realistic for you, then coming to terms with the possibility of never having children may be the only option. Clearly, this will be very traumatic and difficult. Counselling is therefore vital in the acceptance process at this stage.