This document provides guidance for doctors on breaking bad news to patients about failed in vitro fertilization (IVF) cycles. It emphasizes being empathetic, honest, and speaking with compassion when informing patients. It also stresses analyzing what went wrong with the previous cycle, discussing potential protocol changes for the next attempt, and managing patient expectations by preparing them for possible failure. The document encourages doctors to provide photos of embryos, support groups, and counseling to help patients cope with the difficult news.

1. Breaking Bad News (BBN)
of IVF Failure
simple formulae used by us
Dr. Sharda Jain
Dr. Jyoti Agarwal
Dr. Jyoti Bhaskar

2. Breaking Bad News (BBN)
of IVF Failure
simple formulae used by us
Review this Lecture at:
Slideshare.net :

3. IVF Failure
is no joke !!
IVF team faces
Every day this big blow
& do not know
How to handle this ?

4. Doctor, Why Did My IVF
Cycle Fail ?
• IVF failure causes a
lot of distress
Both for patient and
doctors
• Lots of questions
• No clear answers

5. Most Female Patients Blame
Themselves !
• Did the IVF cycle fail
because I did
something wrong ?
• Exercise ?
• Diet ?
• Stress ?
• There is drastically wrong with my body
rejecting the embryo all the time ? ?

6. Please Talk to Your Patient
• Please do not abandon
your patient !
They need you the most
at this time ! As 1st IVF
cycles is invariably a
“TEST CYCLE”
&
You only have the solution

7. Please Talk to Your Patient
•IVF Failure is biggest Bomb shell
• Repeated IVF failure requires very careful
handling
• After an IVF failure, patients
are very EMOTIONALLY
UNSTABLE.
• Can be ANGRY with the doctor
• BLAME you for the failure

8. Please Talk to Your Patient
• The biggest problem is
that Doctors do not
want to talk to
patients when the
cycle fails,
• They are
uncomfortable in BBN
as they are not trained
in 4 walls of medical
college

9. INFORMED CONSENT
Is to be taken seriously
o It is vital for gynaecologists to fully understand
the importance of first counseling &
o Explain success rate of clinic as Compared to
International figures
Video Recording
(if smelling problems !!)

10. INFORMED CONSENT
• It is important to give extra 10 minutes
time
• Counseling must be done by sr. Doctor
beside the regular counselor, as it goes
long way to accept failure …
• 80%, failure is anticipated
• In 20% it s totally unexpected & it drains
your energy.

11. Role of IVF Team
After an IVF failure
•Be empathetic
•Be honest
• Tell the Truth
with compassion
Don’t hide any thing
Speak less in 1st session

12. THE ROLE OF THE PRIMARY
CARE GYNECOLOGISTS
• If You are the patient’s primary care doctor
you can counsel them too.
• You Have a very important role to play !
• Review the IVF medical records available
with the patient
• Check embryo photos !
But all this is possible if you yourself know A-Z
of IVF cycles protocols & infer the Results

13. Critical Analysis of
Previous Cycle by IVF team
•What went right ?
•What went wrong ?
•What have we learnt ?
• Do we need to change the protocol next
time ?
•What do we exactly ?
Keys of Success after IVF failure

14. Troubleshooting : IVF clinic
• Clinic staff behavior … if objectionable
• Superovulation protocol
• Ovarian response
• Endometrial thickness and texture
• Embryo transfer –
* Technical difficulty ?
* Day of Transfer

15. Troubleshooting : LAB issue
• Lab Rating & Quality control
measures
• Fertilisation rate
• Embryo quality in given cycle
• How did other patients on the
same day do ? – IVF count come !!

16. The only good embryo
which becomes a baby !
•We can grade
embryos, but we
still cannot
predict which
embryo will
become a baby !
Good Quality Embryos ?

17. Please give photos of the embryos to the
patient as one picture is better than
thousand words.
• Every patient should insist on
these photos
• It is Documentary evidence of
the quality of embryos
transferred
• Whether you transferred Good
quality embryos for ET ?

18. Additional techniques do help
to improve success rate in IVF.
• Blastocyst
• laser hatching
• Coculture
• Newer tools - Embryo – “omics”
• Better genetic technology
* PGD / PGS – Array CGH –
Good Quality Embryos ?

19. Many Tests Available
• Expensive
• Clinical utility not well defined
• Not validated
• Often lead to more confusion
Good Quality Embryos ?

20. Pressure on the doctor to test
– and treat
• Endometrial function testing ( integrins) - ?
• Endometrial receptivity assay ( ERA) - Yes
• TB PCR - Must
• Immune testing (TNF a , NK cells and immune
therapy)
• Sperm DNA fragmentation
• Metroplasty ( to “improve” uterine capacity) ???

21. Best to Tell The Truth !
• Human reproduction is very complex
• Often, the truthful correct answer is not
available – team does not know why the
cycle failed.
• Over treatment - To be avoided at all
cost

22. Realistic expectations are
needed - patients
• Please set realistic expectations for
your patients before the cycle starts
• Prepare them for failure !

23. Realistic Expectation
are needed by IVF Team too !!
• Often, just need to be patient to achieve
success
• Success in new IVF Centre is a slow
process
• Hard work , wisdom to stay on , Teamwork
is the key

24. Guaranteed Pregnancy Programs
• Help to reduce patient anxiety in IVF – ICSI
cycles . The patient knows that the doctor’s
interests and the patient’s interests are
aligned
• Reduces financial risk
• Helps the doctor Team to learn from
each cycle !
Pay for 2 & 3rd is free (USA)

25. What can we change ?
•Eggs
•Sperm
•Uterus
•Clinic

26. Eggs - too few eggs
( poor ovarian response)
–Superovulation protocol
• Long, Short, Antagonist
• Conventional IVF
• Mild ( mini-stimulation)
–Supplements
• DHEA, antioxidants etc.
–Donor eggs/ Donor embryos

27. Eggs – too many eggs ( PCOD)
• Gentler superovulation
• Metformin
• Myoinositol

28. Sperm
• ICSI ( in cases of total
fertilisation failure , when IVF
was done in previous cycles)

29. Sperm
• Abnormal sperm do not cause abnormal
embryos !
• Sperm FISH and sperm DNA
fragmentation tests are of Questionable
use , due to lack of therapy
• Teratozoospermia is only very very
rarely a cause of fertilisation failure after
ICSI ( globozoospermia)

30. SPERM
• Frozen testicular sperm for ICSI
has a lower success rate
because many of these sperm
are immotile.
• It’s best to use fresh testicular
sperm

31. Difficult Embryo Transfer ?
• Under general anesthesia ?
• On Conscious anesthetist
• Under ultrasound guidance ?
• Change the catheter set ?
Ultrasound guided
ET is routine with us

32. Uterus
• Vaginal ultrasound scan to
evaluate uterine lining
• Routine Hysteroscopy is ???
Most probably hysteroscopy will
be normal if ultrasound scan is
normal & saline infusion
Sonography (SIS) is ok

33. Thin uterine lining
• Vitrify all embryos and then do a frozen
thaw cycle
• Add Estrogen, Sildenifil citrate, pentoxifine
• Endometrial injury to induce improve blood
flow
• Intrauterine perfusion of GCSF
( granulocyte colony stimulating factor)
given on Day of Trigger
• Surrogacy

34. Clinic
• Refer the patient to another clinic
• Can be helpful – second opinion,
other team with a different
perspective !
Lifecare IVF & Surrogacy centre Brig. R. K sharma

35. Information & more information
Therapy : is Vital to IVF Patients
• Patients need to have realistic expectations
! This will help both you and the patient
cope better with failure, when this occurs
• Prepare for Plan B !
• IVF can be a roller coaster ride & need to
relax upto 3 months of pregnancy
psychological counselors – can do the
great job.

36. Be kind !
• Your patients are very emotionally
unstable at this time
• IVF is often their last hope
• When IVF fails, it’s a big blow to couple
• Please talk & Console woman
• Help them to cope with this rough patch
of their life.
Integrity of team, Faith in the team
& Peace of mind is all that needed

37. Support Patients Groups
• Experienced patients with initial
failure can help others !
• This can be therapeutic
• Encourage patients to talk to
each other
• Peer support can be very helpful
(our Experience)

38. Doctors too need
Supporting IVF groups !!
Brig R.K. Sharma
Dr. Sushma Ved
Pear Support can be
very helpful to mature as IVF experts

39. “Ending Treatment”
When to advice patients that
“Enough is Enough”
“is an ART”
Specially in – Repeated Failures,
Rec. Abortions
Bad Endometriosis ,
multiple Fibroids destroying Uterus

40. Useful PRAYER – for both
Patients and Doctors !
“God grant me the serenity to accept
the things I cannot change;
The courage to change the things I
can;
And the wisdom to know the
difference”.

41. ADDRESS
11 Gagan Vihar , Near Karkari Morh
Flyover Delhi -51
CONTACT US
9650511339
011-22414049,
WEBSITE :
www.lifecarecentre.in
www.drshardajain.com
www.lifecareivf.com
E-MAIL ID
Sharda.lifecare@gmail.com
Lifecarecentre21@gmail.com
info@lifecareivf.com