When IVF Fails
There are many reasons why IVF treatment fails and it is well documented that the live birth rate per IVF cycle remains disappointingly low despite the 40 years that have passed since the first IVF procedure was carried out by gynaecologists Bob Edwards and Patrick Steptoe.
It could be the man
Sadly what is not documented or well understood is that a male factor infertility can be one of the reasons why IVF fails. This makes sense when you consider that 50% of all cases of infertility are caused by a male factor, yet despite this most clinics do not conduct any investigation of the male partner beyond a basis semen analysis and as a result IVF can fail.
This is predominantly because IVF/ICSI treatment itself doesn’t improve sperm quality, it simply puts the sperm and the egg together. A huge opportunity is missed to diagnose the cause of a man’s infertility and to treat this improving the chances of natural conception and ironically the IVF process becoming more successful.
Data confirms that if an IVF cycle has failed or ideally before you have IVF that it is very valuable to press pause and investigate the male partner further. Even if that man has had a normal semen analysis result. This may sound strange to get more tests done if your semen analysis is normal but this is because a “normal” semen analysis does not mean that the man is fertile.
Most of my patients are very surprised when I tell them this but the fact is It is wholly possible for sperm to look normal following a semen analysis test but be genetically abnormal. For this reason we recommend a more in depth examination of sperm at the genetic level called a DNA fragmentation test.
At Fertility Solutions we recommend DNA fragmentation testing to those couples that have been trying to conceive for more than a year, have undergone an unsuccessful IVF cycle or have suffered an early miscarriage. We consider the reproductive history of the male partner, their previous semen analyses and whether they have had a previous IVF cycle fail.
We then undertake a DNA fragmentation test and when the results come back, we review them with a specialist team. The team approach includes a gynaecological, urological and embryology approach to actually give the patient as much information as possible to determine if a male factor could be contributing to IVF failure or not. When IVF fails and it is caused by the male factor, the patient should see a urologist who will work to first diagnosis, and then to improve sperm quality and therefore improving the IVF cycle outcome.
It is important that male factor infertility is investigated at an early stage of the IVF journey. Investigating the male factor early can offset the effect of the woman’s reduction in fertility with age when progressing through many rounds of failed IVF as well as considering the significant cost of many IVF cycles.
One of the most difficult situations we see on a regular basis is when the couple is not assessed as a whole early in their fertility journey. If this had happened and the man had been diagnosed earlier it would have saved time and money and led to a more positive outcome for the couple.
There are many potential diagnoses for men including infection, varicocele or obstruction which can be treated and improved, thus improving and creating the opportunity for the couple to get pregnant without the need for IVF.