• Poor quality of eggs: In patients with low AMH, more than 35 years age, PCOD & endometriosis.
Suboptimal sperm quality especially ICSI patients with sperm problems.
• Poor embryo quality: How was embryo dividing throughout its development was it adequate/ timely division? Does it look like as it should be on particular day of transfer, 60-70% of good looking embryos may be genetically abnormal.
• Endometrium: Well-nourished receptive endometrium has to be adequately thick at the time of transfer. Endometrium thickness with more than 6-7mm is usually good enough. But in patients with thin lining, repeated IVF failure, recurrent miscarriage in the past. In few selected patient endometrial scratching is performed to improve endometrium. PRP Therapy (Platelet Rich Plasma) in which platelet rich plasma is inserted in uterus with the help of plastic cannula to improve endometrium. Hysteroscopy is also recommended in such cases to have a direct look at the endometrium, to know the cause of thin endometrium & treat it as well at same sitting.
• Procedure of ET: Process should be smooth & painless. If the procedure is traumatic, painful, difficult & bloody sometimes this can lead to failure as well.
• Improper response of the ovaries to the ovarian stimulation protocol used hormonal imbalances created by injections given to produce eggs which might put the uterine line (endometrium) out of phase for receiving the embryo. In such cases FREEZE ALL & FROZEN EMBRYO TRANSFER is recommended.
• Even if all goes well failure might be unexplained & requires more cycles/attempts.