Infertility is considered a disease that affects 17% of Spanish couples of reproductive age according to the Spanish Society of Fertility (SEF). For the affected couples, in vitro fertilization (IVF) either with own or donated eggs (egg donation) often represents the most effective treatment to fulfil their greatest desire: a healthy baby at home. However, there is some risk that these treatments can fail.
- 1 Are there any symptoms or signs after the embryo transfer that indicate that IVF will be negative pregnancy test?
- 2 If I have vaginal bleeding, is it indicative of a negative result? Should I go for the β-hCG test?
- 3 What will the period be like after a negative pregnancy test?
- 4 Causes of IVF failure
- 4.1 Most relevantpre-treatment factors:
- 4.2 Post-failure factors:
- 5 When to try again after a negative negative pregnancy test
- 6 Emotional support: negative IVF and… now what?
- 7 How do I feel after a negative attempt?
- 8 What can I do? Recommendations of a psychologist after a negative β-hCG result
Are there any symptoms or signs after the embryo transfer that indicate that IVF will be negative pregnancy test?
The only reliable diagnostic test to establish the success or failure of assisted reproduction treatment is the pregnancy test. It can be done either in urine or through a blood test to determine the level of β-hCG hormone (“beta”).
The presence of certain symptoms similar tothose that appear at the beginning of pregnancy, around performance of thistest, are not indicative of the result. Many of them, such as the feeling ofabdominal discomfort, nausea, tiredness or sleepiness are related to the effectof the drugs used in the treatment and may appear even if there is nopregnancy.
On the other hand, the absence of symptoms doesnot rule out a positive result, since gestation at its beginning is oftenasymptomatic.
If I have vaginal bleeding, is it indicative of a negative result? Should I go for the β-hCG test?
Vaginal bleeding is a symptom that does notnecessarily imply treatment failure. In fact, it may even indicate thatimplantation has occurred. This is called embryoimplantation bleeding.
Therefore, even if the vaginal bleeding occurs in thedays around the β-hCGtest, it should be performed on the scheduled day informing the specialist ofthis circumstance.
Due to the frequency with which this symptom appears in cases of positive pregnancy test, we should NEVER abandon the prescribed treatment until the result of the ?-HCG analysis is known.
What will the period be like after a negative pregnancy test?
The time when menstruation appears dependsmainly on the treatment used. For example:
- In patients who have undergone an embryo transfer in a natural cycle, the period usually starts on the usual and expected day.
- When we administer hormonal medication, it will start two or three days after the treatment has been discontinued. If it does not appear after two or three days, it is recommendable to consult the doctor.
It may be that the first period is different induration and intensity than usual.
Causes of IVF failure
Since there are many causes of infertility and oftenseveral of them are combined, it is very risky to establish a common prognosisfor all the cases. It, therefore, implies a personalized evaluation of eachcase.
It is important to differentiate between the factorsto be studied before treatment and the factors that would have a prognosticvalue when another IVF attempt is carried out after a failure.
Most relevantpre-treatment factors:
- Maternal age. As we explained in this post, the effect of advanced age causes a decline in the number and quality of oocytes.
- If the starting point of the treatment is an altered massculine factor.
- Body mass index (BMI). In women, the ideal BMI is between 19 and 30. Its deviations, especially BMI >30, can lead to a low rate of fertilization and pregnancy. In this case, the patients tend to have ovulatory problems and present a higher risk of miscarriage. In men, obesity adversely affects their reproductive system and it has been observed to tend to increase oestrogen level and reduce testosterone level.
- Cause of infertility. Whether it is single or multiple.
- Having endometriosis.
- Antral follicle count (AFC). It is directly related to maternal age and anti-mullerian hormone (AMH) values. With increasing age, we observe a decrease in the follicle count and AMH values.
- Toxic factors. Habits of use of harmful substances, such as tobacco and alcohol, as well as environmental factors, impair treatment outcome.
- If the cause of the sterility is of unknown
- Anatomical abnormalities that may difficult the pregnancy.
- Suffering from a tubal factor.
- Ovarian factor. Depending on the ovarian response in a previous cycle, we can modify and/or customize a new attempt based on certain hormone levels. Also, progesterone levels can help us know if endometrial receptivity is optimal.
- Endometrial factor. Abnormalities in the intrauterine cavity, poorly proliferated endometrium, endometritis, immunological factors and blood coagulation abnormalities are the causes of repeated implantation failure (learn more)
- Semen quality. Although with a low number of spermatozoa we can carry out an ICSI, there are certain parameters that could influence the rate of fertilization and that must be considered in a new attempt.
- Embryonic quality. Embryos that reach the blastocyst stage are classified according to their degree of expansion and the quality of their cells. Consequently, a good quality embryo will have a higher pregnancy prediction rate (learn more)
- Laboratory quality control. This category includes air quality, pH, type and characteristics of incubators, use of dim light and type of media in which embryos are cultured. The IVF laboratory must guarantee the best conditions for embryo development
- Experience of embryologists.
When to try again after a negative negative pregnancy test
In cases where the strategy to be followed is another ovarian stimulation, it is recommended to allow 2 to 3 months to pass. During this time, the medical team and the embryologists will always work together to try to find the cause of the negative β-hCG and the patient will be allowed to make decisions with more calm and let her ovaries rest after the previous stimulation.
Alternatively, and without any doubt, it is not necessary to wait if the plan is to perform a frozen embryo transfer after the negative IVF . In this case the ovaries are “not necessary” and with menstruation the endometrium will have regenerated completely. Therefore, an endometrial preparation will be carried out and thawing of the embryo and its transfer will be performed.
Similarly, each case will be individualized takinginto account the situation and medical history of each patient.
Emotional support: negative IVF and… now what?
When youwish to see a positive result and you receive negative news, a whole lot ofemotions run through your body. Having invested time, energy, emotions, plans,savings etc. makes us experience frustration in this delicate moment.
How do I feel after a negative attempt?
- SHOCK: my mind is not ready to receive this news andgoes into a “blocked” mode in order to cope with the situation. It is a timewhen I cannot understand even the explanation that the doctor gives me.
- EMPTYNESS inside my body: it is like a small mourningthat is feeling pain caused by not having been able to get pregnant in thistreatment.
- SORROW: accompanied by the feeling of not being ableto continue, with the thought that it is unfair, and it comes to my mindrepeatedly: Why me?
- GUILT: I look back and analyse, again and again,what could have been the cause of the negative result, if I have done somethingthat has influenced it, if I have not followed the treatment well or if I hadstarted looking for it earlier…
- FEAR: I look to the future and worry that I willnever be able to achieve it. This thought tortures me…
What can I do? Recommendations of a psychologist after a negative β-hCG result
- LISTEN TO YOUR BODY AND LET IT FLOW. Give yourself time to “digest” thesituation, everyone needs a different rhythm.Let the emotions emerge as they come, without judgment, withoutexpecting to feel a particular way, let them flow and your energy adjustgradually. Look after yourself and listen to your body.
- FOCUS THE ATTENTION ON YOURSELF. Observe your sensations, youremotions and perform activities that generate internal peace. Try not torecreate the thoughts of the following type: “What could I have done wrong“, “if I had not done such a thing…” because they areaccompanied by guilt, and they can generate discomfort in you.
- CONNECT WITH THE PRESENT MOMENT. After a negative β-hCG it is not necessary to make decisions, nor to ask ourselvesquestions about the future in absolute terms such as: “what if I never become a mother?“.On the contrary, it is time to channel your energy based on the day to day. Redirectyour thinking to: “Today I havepossibilities, I will continue trying”.
- TRUST in yourself. Trust in your body, in the chosenprofessionals and in the possibilities and opportunities that in vitro fertilization allows us tohave.
- GET READY FOR A NEW WELCOME. Check if you are ready for thenext transfer. Check your eating habits, physical exercise, sleep, mentalhygiene… to improve them if necessary. They will help you to feelbetter.
- MAKE DECISIONS. After a few days and with amedical explanation of your diagnosis, it’s time to make decisions. Plan yournext transfer or next steps.
Our Psychology Unit offers you the emotional support you need to get through the difficult times.