# IVF Lottery



## alicer (Dec 11, 2002)

Dear Peter

I'm really confused about why IVF may fail a couple of times and then suddenly succeed - surely for an individual the egg quality is the same, the first second or third time? i understand that different quantities of drugs may increase the number of eggs but surely the eggs are going to be of the same quality? I saw in the paper that a woman had had 5 attempts at IVF in her twenties and thirties and then suceeded at 39, but logically you'd think that she would have been more likely to suceed in her twenties? 
thank you
Alice


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## peter (Oct 2, 2002)

Dear Alice,

This is a very good question which is almost impossible to answer!!

The problem is that reproductive physiology is such a complex subject and we as scientists have only really scraped the surface in terms of understanding. Clinics around the world are transferring beautiful embryos into young, tubal recipients but still no preganancy results. The problem is that we have very little understanding if the implantation process and no method at all of encouraging or improving it. I personally have seen one patient who became pregnant on her 14th attempt!! The previous attempts were all very similar but I have no idea why the 14th worked! In the same way I have seen many pregnancies result from the 1st attempt.

As the years go by and as research progresses I am sure that we will slowly understand implantation and therefore be able to manipulate it. until that time IVF does remain a bit of a lottery.

Hope this helps,

Peter



alicer said:


> Dear Peter
> 
> I'm really confused about why IVF may fail a couple of times and then suddenly succeed - surely for an individual the egg quality is the same, the first second or third time? i understand that different quantities of drugs may increase the number of eggs but surely the eggs are going to be of the same quality? I saw in the paper that a woman had had 5 attempts at IVF in her twenties and thirties and then suceeded at 39, but logically you'd think that she would have been more likely to suceed in her twenties?
> thank you
> Alice


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## alicer (Dec 11, 2002)

Thanks Peter that's a really interesting answer. Would it be possible please to explain what happens when an egg is inserted back into the womb. I know this sounds silly but does it swim around for a few days in the womb or does it implant straight away? And in terms of implantation does progesterone medication or anything else help this process along? I've heard a lot about assisted hatching but my clinic doesn't do it, so i wonder how an embryologist can tell if you need it or not and why all clinics don't offer it?
Final query ( sorry to ask so many questions) - are there any tests that can be done to asses implantation success (I've had an endio biopsy/lap and everything was OK)
Pheew!
Alice


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## peter (Oct 2, 2002)

Dear Alice,

Some good questions!!

When the embryos go back into the uterus they move around freely until around day 4-5 when they implant.

Progesterone is essential for implantation and most clinics prescribe cyclogest pessaries in order to ensure that progesterone levels are high enough.

Assisted hatching is when a cut is made in the membrane surrounding the embryo. This may help implantation in patients who have had many failed cycles or when the embryologist thinks that the membrane looks particularly thick. Not all clinics offer this becuase the embryologist must have a HFEA licence to carry out the technique.

Some clinics check the thickness of the endometrium by scan at the time of transfer and these clinics will not tranfer if the endometrium is thin. otherwise, there is no specific way of assessing implantation at the moment.

Hope this helps!

Peter


alicer said:


> Thanks Peter that's a really interesting answer. Would it be possible please to explain what happens when an egg is inserted back into the womb. I know this sounds silly but does it swim around for a few days in the womb or does it implant straight away? And in terms of implantation does progesterone medication or anything else help this process along? I've heard a lot about assisted hatching but my clinic doesn't do it, so i wonder how an embryologist can tell if you need it or not and why all clinics don't offer it?
> Final query ( sorry to ask so many questions) - are there any tests that can be done to asses implantation success (I've had an endio biopsy/lap and everything was OK)
> Pheew!
> Alice


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