Secondary Infertility and failed IVF
Recently I have seen several couples who have a child, but have had difficulty in conceiving a second time. Their first child was conceived easily, and they consulted with specialists after failing to conceive within 6 months of trying. In both case, the fertility groups didn’t bother to perform a routine infertility investigation, but recommended going straight to IVF (in vitro fertilization). The logic of the fertility experts was why bother to diagnosis the problem, and instead focus on the objective; getting the patient pregnant. Never mind that the groups stood to gain a significant revenue stream to their practice by recommending the IVF procedure.
Both couples diligently followed the recommendations of the specialists, and pluged into the IVF protocol. Unfortunately for both couples they both went through two cycles of IVF without conceiving. The majority of the eggs obtained resulted in abnormal embryos after fertilization, and were not transferred. This is the norm for most IVF cases in that there is a high percentage of abnormal embryos are produced in the process. Clearly with approximately a 20 to 25% clinical miscarriage rate in humans, these embryos either would have not resulted in a pregnancy if produced as a result of intercourse. So the critical question remains, are many of those embryos obtained in an IVF cycle abnormal, or is there something about the IVF process itself that results in abnormal embryos.
After both couples consulted with me I strong recommended a traditional infertility work-up. In both instances each couple had a minor problem that was picked up in the work-up. They were both treated appropriately, and both of them conceived and delivered a normal child. In fact, one couple has had a second child with appropriate therapy.
The take home message: there is good indication to perform a traditional infertility work-up in couples who have secondary infertility. Most therapy is not very costly nor dangerous, and the success rate is very high.