We all know that IVF works, but also it fails. When IVF fails, it can be very frustrating, often leading to anger, disappointment, dashed hopes, and sometimes a lot of blame being traded, because of everything that has been invested into it; money, time, and emotion. A cycle of IVF is akin to what happens in the human body in the woman in a month. Everything that we do in IVF is to replicate what happens in the woman’s body on a monthly basis. So a cycle is like what happens to a woman in a month. Human reproduction consists of two major steps, fertilization and implantation. Fertilization is the bringing of the sperm and egg together and implantation is the uterus accepting the embryo that has been presented to it. Let’s look at it from the point of planting a seed that germinates. We know every seed that you plant germinates, but in this case, the embryo will represent the seed and the lining of the uterus will represent the soil. It is when you see the germination or the sprouting of the seed, when it grows out of the soil, that you can say that you have succeeded. The same thing is when you say a pregnancy, or you can detect pregnancy, that is when we know that implantation has taken place. For this to happen, there must be some raw materials. We need good quality eggs, not just any egg. We need good quality sperm, and then we need the proper union of the sperm and the egg or what we call fertilization. IVF means In vitro fertilization, fertilization outside the body. So what happens in fertilization is that there is exchange of genetic materials between the man and the woman. So a lot of genetic factors come into play here. After the union of the sperm and the egg, what is needed are good quality genetically normal embryos. When you have good quality, genetically normal embryo, then your uterine lining needs to be of good quality. So that there can be interaction between the good quality genetically normal embryo and the lining of the uterus. This is where the experience of the doctor comes in., to do a smooth embryo transfer. After all these procedures, implantation can now take place. Which is just the synchronization between the embryo and the lining of the uterus. That is when you can have a successful IVF cycle. We know that the success rate of IVF when you are less than 35 is a peak, gives you about 30 to 40% baby take home rate and that decreases to 5% when you are about 40. In the body naturally, a woman has a chance between 20-25% every month. In other words, IVF delivers better success rate than what nature itself can present. So IVF is a little bit more efficient than nature. We know that human reproduction is one of the most inefficient processes in the body. And this is not surprising because there are so many quality control systems in the body. This is why we can beat our chest and say that IVF babies are normal babies. Factors that determine the quality of eggs Age: Age is the most important factor in determining the quality of eggs. Drugs: So many clinics will devise ways because especially in our environment, where power is not stable, many people will devise a way to store drugs. The drugs must be properly stored so that the cold chain is maintained, and also, the administration of the drugs is important. If it is supposed to be under the skin, you cannot put it into the muscle, if you want to get the result that you want. One other thing about drugs is the timing. If it is 10 o’clock, then it better be 10 o’clock. If you use it at 11 o’clock for any reason, you must tell them at your clinic that you didn’t take your drugs at the appropriate time so that we know if we need to juggle things around. It is much better for you, to keep to the time that was allotted for the drugs. Then the stimulation protocol is of importance. You must use the right stimulation protocol and the right dosage of drugs in order for you to get good quality eggs. The other thing we talk about is sperm quality. Age also contributes to sperm quality. When we talk about sperm quality, some people get it wrong. The function is what is important in sperm, not the morphology. Don’t forget that when we are doing semen analysis, what we look out for most of the time is the morphology of this sperm. We talk about volume, count, and morphology. But here the important thing is actually the function of the sperm, which we cannot find any test for now. But there are some other things that we can do. Then the exposure to very dangerous toxins. For example, people who smoke, gardeners who are exposed to chemicals and even some people who were exposed to radiation. There is something we call DNA damage, which we now see in men who were exposed to these toxins. For example, people who work in petrochemical industries. That is one thing we are also looking at, which might affect the quality of the sperm and its function. If the quality of the sperm and the quality of the eggs are not good, it might be challenging to have a baby. The embryo quality is so important. Sometimes the embryo looks normal but they are not good quality, genetically normal embryos. If there is any error here, this is where age comes in, if either the man or the woman are advanced in age. You can have embryos that are looking normal, but are genetically abnormal. One other thing that can contribute apart from age is the condition in the laboratory. When the transfer depends on the doctor and the…
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