The Key to Our Pregnancy Success Rate

Having to go through repeated miscarriages and failed embryo transfers can be heartbreaking. However, opting for the right treatment at the right time has a high potential to improve the patient’s chance of conceiving and increase our pregnancy success rate. It is important to do the necessary tests to find out the problems and try appropriate treatment. There are various treatment options to treat your fertility issues and help you to get pregnant.

“There are no guarantees in fertility treatment, but I believe the right treatment at the right time will greatly improve a patient’s chance of conceiving.” Dr Navdeep Singh Pannu

 Improving the Odds

For some couples, having a child can be a difficult process due to physiological factors. Did you know that up to 25% of clinical pregnancies end up in failure? Clinical pregnancy here refers to the pregnancy verified by the doctor through an ultrasound or fetal heartbeat. There are various reasons for clinical pregnancy to fail, but I believe that the combination of the right treatment at the right time can increase the chances of successful pregnancies.  

Reasons for Failure

There is a number of reasons why some patients did not achieve live birth or clinical pregnancy. Here are a few reasons why your IVF might have failed.

–     Chromosomal Abnormalities

For an IVF process to be successful, there must be a ‘chromosomally normal’ embryo where the number of chromosomes is perfectly normal. If it is not, it will lead to failure of the procedure or worse, a miscarriage. The abnormal chromosomes affect the quality of the embryo. In many cases, this condition occurs more commonly in women over 35.

–     Age

Chances of miscarriage increase as you grow older. You gradually lose the best eggs. If you are 35 and above, you have a higher risk of getting a miscarriage. At 35, the percentage of miscarriage is about 20%. At age 40, the percentage increases to 40% and at 45, it shoots up to 80%. Thus, when you conceive, there is a high chance that the embryos may be abnormal.

–     Blood disorder

Another possible reason is when you suffer from blood disorders which affect the immune system. A condition that can occur is Anti-Phospholipid Syndrome. It refers to abnormal clots forming behind a growing placenta, leading to miscarriages.

–     Health issues

Women with underlying health issues, such as uncontrolled diabetes or thyroid problems, may have chances of miscarriages. A womb with an abnormal shape can also be a contributing factor in miscarriages. The womb should be of normal shape and dimension with a smooth inner lining. Besides that, if the woman has a polyp or uterine fibroid making the womb lining irregular, it can also cause miscarriages.

What aspects do we look into before suggesting the right treatments?

Once the problem is detected, the treatment can be decided. The treatment will be personalised according to the patient’s chances of conceiving. To personalise the treatment, there are four areas that we look into:

     Ultrasound Scan of The Womb and Ovaries

Ultrasound scans are done to check for problems in the womb and ovaries. It can detect abnormal structures of ovaries or unusual growths like fibroids or cysts.

–     X-Ray To Check For Blocked Fallopian Tubes

This X-ray test is done to check the uterus and fallopian tubes. It can help detect fertility problems that occur from blocked fallopian tubes. If the tubes are blocked, the sperm can’t travel to the egg or fertilized egg cannot pass through to the uterus. This leads to infertility problems.

     Hormonal Blood Test

This test helps to identify hormonal imbalances that can affect infertility. The blood test checks a hormone called progesterone. It checks whether a low level of progesterone influences the infertility rate. The Anti-Mullerian hormone level is also tested to check the ovarian reserve which refers to testing how many eggs you have. Other tests include checking the level of Follicle-stimulating hormone (FSH), Luteinizing hormone (LH), thyroid and prolactin in the blood.

–     Sperm Test

Sperm tests check the health of the sperm. It helps to determine if there is any sperm dysfunction that may cause failure in pregnancy. If there are low sperm counts, there may be lifestyle changes you have to make. Moreover, you might be given medications to increase sperm production. You may also have to undergo ICSI or IVF treatment depending on the sperm count. 

What are the treatment options available?

There are many treatments available for infertile couples. However, finding the proper treatment at the right time is the key to our pregnancy success rates. Here are a few treatment options that may be suggested by your fertility doctor after assessing your condition.  

–     Timed Intercourse

Firstly, we can advise couples to have intercourse around the most fertile day of the woman’s ovulation cycle. Timed intercourse is simple and can be effective for some couples. Firstly, you have to determine your ovulation or fertility window. It is usually 12 to 14 days before the next period starts. Having intercourse during this time increases the chances of pregnancy.

     Prescribing Hormonal Medications

We can also prescribe hormonal medications to help regulate or induce ovulation. The medicine helps to increase the production of eggs in a woman.

     Intrauterine Insemination (IUI)

IUI is suggested for patients who do not have complicated infertility issues. The husband’s sperm is processed and injected directly into the womb during this treatment. The semen sample collected will be washed to concentrate the sperm and remove the seminal fluid. It will then be injected near the patient’s ovulating time to increase conceiving. IUI procedure can increase the success rate of conceiving by 15% to 20%.

The Test Tube Option

  • In Vitro Fertilization (IVF)

It is popularly known as a ‘test tube baby.’ A woman is given a hormonal injection for ten days during this process. It will help the eggs to mature quickly. After that, we will extract the eggs while you are under anesthesia. Upon egg retrieval, sperm is injected directly into the egg to fertilise. We will then inject the fertilised embryo into the womb five days later. After two weeks of waiting, a pregnancy test will be done.

Additional Tests To Increase Our Pregnancy Success Rate Via IVF Treatment

The additional testing suggested below is important to increase the chances of a successful pregnancy. It is often recommended if you had recurrent transfer failures and failed to conceive despite the transfer of healthy embryos. These tests are also suggested if you had multiple miscarriages due to abnormal fetus growth.

  • Pre-implantation Genetic Testing (PGT)
    When the IVF treatment did not work, we may consider additional test such as PGT. It is done to determine the best embryos to be transferred. A small number of cells are extracted from each embryo for chromosome analysis which will help to determine if the embryos are healthy.
  • Endometrial Receptivity Analysis (ERA/MIRA)
    ERA/MIRA helps to determine the best time frame for the implantation of the embryos in women. After selecting the best embryo to transfer, ERA/MIRA will signal the best time to transfer these embryos. Combining PGT and ERA/MIRA can increase the conception rate up to 80%.
  • Endometrial Microbiome Metagenomics Analysis (EMMA)
    This test checks good bacteria in a woman’s womb lining. If you have imbalanced bacterial flora, you will be prescribed probiotics to correct the situation before undergoing fertility treatments.
  • Analysis of Infectious Chronic Endometritis (ALICE)
    Another additional procedure is the Analysis of Infectious Chronic Endometritis (ALICE). As many as 30% of women have chronic infections of their womb linings. This imbalance of harmful bacteria can cause implantation failure, which could be corrected with a course of antibiotics. Once this procedure is done, the woman can proceed with the infertility treatments.

Do not Give Up

Every problem has a solution. It might take a while to figure out the core problem and find solutions. Nevertheless, there are solutions to it. Do not give up. Talk to your doctor and try treatments or methods that are recommended by your fertility doctor. There are various treatments for infertility problems such as timed intercourse, IUI and IVF. Carrying out appropriate treatment at the right time in the right way can lead to successful pregnancy and increase our pregnancy success rate.

One of my patients was in her 40s when she first met me. She approached me after experiencing repeated miscarriages despite having healthy embryos. After administering a few of the additional tests mentioned above, I was able to identify the problems. Then, I proceed to treat the problems and conduct the next transfer. It was successful. She recently gave birth to healthy twins. There can be no better vindication for the treatment than a successful pregnancy. Thus, do not give up.

There are solutions to your infertility problem. It might go through a trial-and-error phase in order to find the right solution for you. Finding the right treatment at the right time makes your parenthood dream come true.

Find out how you can get ready for IVF here : Let’s Get Ready for IVF

You are sure to have many questions. In addressing infertility, the sooner you have them answered, the better. Do list them down and call 03-80699333 (TMC Fertility & Women’s Specialist Centre, Puchong) or +6-03-62871000 (Thomson Hospital, Kota Damansara) or email ask@drnavdeepfertility.com to make an appointment to consult with Dr Navdeep.