“My cycle failed at another clinic. What would you look at differently?”
Forensic evaluation of a failed cycle: the lab and clinical review
Forensic evaluation of failed IVF cycles involve combination of looking at lab and clinical aspects. Basically the use of lab techniques like assisted hatching, extended embryo culture, whether ICSI is used, day of embryo transfer, whether PGT-A is standard or optional, whether the embryo transfer is fresh or from frozen warmed embryo and paramount of all the actual stimulation protocol with the fertility medications and whether a preparatory step was done prior to stimulation, dosing, the trigger medication type (Lupron or HCG) and the days of stimulation paying attention to the size of the follicles.
All these things matter.
Forty years in the field, applied to cases that don’t fit the perfect prognostic group
My background is working in the field for forty years and being involved in all the pioneering steps in IVF; the good the bad and the fantastical. This experience and my academic background and leadership in education and research allows me to create a wisdom that can be applied to customize cases and give personalized care. Problem solving especially for those patients who don’t fit into the perfect prognostic group – which is the majority.
Why large programs don’t benefit the patient who isn’t straightforward
Large programs actually don’t benefit the patient who isn’t the straight forward excellent prognosis because they need to follow clinical algorithms in order to function. There cannot be extensive discussions among staff to process large numbers of cycles daily with nuances of clinical performance. A failed cycle is certainly scrutinized but then placed in a secondary algorithm that can have similar performance. Medicine should be individualized for each patient with attention to detail from the beginning.
When I review a patient with a failed cycle
When I review a patient with a failed cycle(s) this is what pops out immediately.
Nuancing the protocol, and what to bring to the consult
Basic tactics to improve egg number or quality can be nuanced with the stimulation protocol; even as simple as more days of stimulation not necessarily dose manipulation. Some patients need better endometrial lining preparation such as PMOS (formerly known as PCOS) and are best served with frozen embryo transfers rather than fresh. Every case is different, but there is usually an option to discuss other than the “nuclear option” of donor egg. My best advice is to come for the consult with lab data and stimulation sheets from prior cycle – this can help but there are five or six protocols we use designed to enhance prior failed attempts and we can review the choices with you.