While most in vitro fertilization (IVF) cycles proceed as planned, some cycles may need to be postponed or interrupted. It is important to be aware of these potential problems before undergoing treatment.
During pre-treatment screening, an ultrasound will check for ovarian cysts. If one or more cysts are present, your IVF cycle may be delayed. Cysts may interfere with the proper development of your egg cohort and it may be best to wait for resolution of the cyst before continuing treatment. In general, most cysts will clear up on their own in one or two months. If the cyst does not spontaneously resolve medication may be provided. In rare cases the cyst may need to be aspirated in a minor surgical procedure if observation or medical therapy is ineffective.
Poor Response to Stimulation Drugs
Some women respond poorly to the fertility medications used to stimulate the ovaries, and will not produce enough eggs. Usually, if a patient grows fewer than three follicles, the chances of achieving pregnancy are not ideal. This low yield will often result in a canceled IVF cycle, and a different medication regimen may be considered for any subsequent cycles. If your diagnosis permits, insemination may provide an equally effective option in that cycle. Please consult with your fertility team to see if this an option
Drop in Estradiol Level
Estradiol is a type of estrogen that is produced in your ovaries. As egg follicles develop, levels of estradiol increase continuously through the stimulation cycle. If there is an unexpected drop in this hormone level, there may be a problem with follicle development, and the cycle may be cancelled. Your physician may consider another protocol or simply wait for another month to start again.
Few or No Eggs Retrieved
Normally, an ultrasound examination will detect the number of mature eggs prior to retrieval, but in some cases, fewer eggs than expected are collected. In rare cases no oocytes are obtained and the cycle will need to be cancelled. In these situations, your physician will evaluate your cycle, review the stimulation and trigger medications and attempt to remedy this outcome for the next cycle.
Poor egg or sperm quality may hinder the fertilization process and yield a low number of embryos. It is uncommon for there to be no fertilization at all, but in these cases the cycle will have to be cancelled. Your physician may consider the types of medications used for stimulation and perhaps the duration of the stimulation as well. Male health parameters will be re evaluated and the embryologists opinion will be sought. A team recommendation is formulated and another attempt is undertaken once a thorough review of the cycle is complete.
Embryos may stop development in the laboratory. Embryos are typically checked at fertilization, on day 3 of development and at the blastocyst stage (day 5). During these scheduled checks the embryologist may unfortunately determine that embryo development has ceased. Your physician will collaborate with the embryology team and formulate a revised treatment plan.
Just as your ovaries can “under-react” to fertility drugs, they can “over-react” as well. An excessive response to fertility medications may result in the development of too many follicles. This increases the risk of ovarian hyperstimulation syndrome, and the cycle may be cancelled. Subsequent cycles will be tried with an adjusted medication protocol.
Unsuccessful Embryo Screening
In some cases the embryo may be screened for chromosome analysis or specific genetic disorders. In some cases, all tested embryos may be abnormal and not suitable for transfer. Please speak to your physician regarding the specific risks of your case and the likelihood of a successful screened cycle.
Although canceling a cycle can be very disappointing, it is often a necessary course of action. Abandoning a cycle may help you avoid more serious complications and ensure a best chance of success in the future. A thorough evaluation of your case by your physician and embryology team will improve the odds of a future success.
Dr. Tanmoy Mukherjee, a board-certified Gynecologist and Reproductive Endocrinologist, is Associate Director of the Mount Sinai Division of Reproductive Endocrinology and co-director of Reproductive Medicine Associates of New York. He completed his residency at the Albert Einstein College of Medicine where he received the Leo M. Davidoff Society Award as well as the Schulman Award, and completed his fellowship at Mount Sinai Hospital. The author of numerous journal articles and textbook chapters, Dr. Mukherjee is also the recipient of the prestigious Society of Reproductive Surgeons Award for his extensive research in ovum donation and medical therapy for the treatment of infertility.