"Graeme is one of the most knowledgeable, reliable and empathic clinicians I have known. His practice is evidence based and patient centred, and he is the 'go to' person for difficult clinical cases." WL (UNSW)
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Repeated Pregnancy Failure
Recurrent Implantation Failure(RIF)
This is an expected, however unfortunate, reality of human reproduction. Not all embryos are meant to implant. Up to 70% of embryos created, either via natural conception or IVF are lost before birth usually within the first three months of pregnancy and most of these even before implantation. However, in our experience, with persistence, thorough investigation and often simply taking a different approach, most patients will eventually achieve a pregnancy.
Causes of recurrent implantation failure may be varied and involve:
Maternal and Paternal health
Combination of these factors
The quality of a woman’s eggs is important in creating a healthy embryo. The reason for this is that the egg does most of the work in accepting the DNA from sperm and facilitating the mix of genes resulting in the creation of an embryo. As maternal age advances, the percentage of chromosomally abnormal eggs increases, reducing the chance of creating a healthy embryo naturally. The proportion of embryos that are chromosomally normal ranges from 50% for those created from an under 30 year old woman’s eggs, to as low as 5% for eggs from a woman over 44 years of age.
There is also growing evidence that low ovarian reserve is associated with poor oocyte quality (egg health) and a past history of endometriosis and ovarian surgery may also reduce egg health and quantity.
The investigations for egg health include an anti-mullerian hormone (AMH) blood test which is a measure of ovarian reserve. In the setting of IVF low AMH may be related to poorer pregnancy outcomes.
Egg quality may also be assessed during the IVF process by observing the capacity of an embryo to grow to the Blastocyst stage. At IVFAustralia we use a special technique called PolScope (Oosight Technology) which allows us to assess the egg in more detail before fertilisation. By using polarised light we can look at the structure of the egg including its spindle which is a critical component of eggs involved in organising the chromosome pairs so that a proper division of the pairs can occur as the egg is developing. An abnormal spindle can predispose to development of chromosomally abnormal eggs.
Treatments to improve the health of eggs may include:
Increase dose of stimulating drugs to obtain more eggs;
Addition of androgens and growth hormone in patients who are defined as poor responders
Use of PolScope in selection of the best egg prior to IVF treatment
Use of sophisticated pre implantation genetic screening of embryos for selection of the healthiest embryo(s)
• Oocyte donation may be an option to consider
NOTE: The benefits of the use of herbal treatments or acupuncture are uncertain.
The main function of sperm is to move and transmit healthy DNA in to the oocyte to make a healthy embryo. In some men for various reasons sperm function may be poor and the DNA may be damaged. Factors affecting sperm quality may include:
Lifestyle (excessive alcohol, obesity, smoking, steroid use, recreational drugs)
The main investigation for a man is a semen analysis which will measure the number of sperm, their motility (ability to move), their morphology (size and shape), and the volume and consistency of the ejaculated sample. If sperm abnormalities are found, the test is repeated to assess the type and degree of the problem. A sperm DNA fragmentation test can be performed to look at the DNA quality of sperm and if indicated we can perform a blood chromosome test on the male.
Sperm have a lifecycle of 72 days, so if a man is ill or stressed, sperm quality is affected.
Treatments to improve sperm quality:
The use of antioxidants can improve sperm quality
Lifestyle will improve sperm quality
Complex Treatments may be Indicated:
Intracytoplasmic sperm injection (ICSI)
At IVFAustralia we use a special technique under high magnification to select the best quality sperm (Digital High Mag)
Testicular biopsies may yield less DNA damaged sperm
Donor sperm may be an alternative option
NOTE: The benefits of the use of herbal treatments or acupuncture are uncertain