Every question you ask can be matched with a suitable answer
Leave me a message
We take every suggestion of yours seriously
Wechat
Tan Xiaojun
·Senior reproductive medicine expert
·Postdoctoral fellow at Peking University
·PhD candidate at Xiangya School of Medicine, Central South
University
·Master’s tutor at Central South University
· Master's degree candidate in reproductive
medicine at the University of South China
· Professional training at Huazhong University
of Science and Technology and Tongji
Hospital Reproductive Center
Expertise:
diagnosis and treatment of infertility, first/second/third generation IVF (including
egg/sperm donation), microsperm retrieval, embryo freezing and resuscitation, artificial
insemination (including husband's sperm and sperm donation), paternity testing, chromosomal
disease
diagnosis, high-throughput gene sequencing, endometrial receptivity gene testing and other
clinical
technology applications. Many of these technologies are at the leading level both domestically
and
internationally.
What additional tests are usually needed after two test-tube failures, such as after test-tube baby failure, repeated transplant failure, uterine cavity evaluation, embryo chromosome screening, sperm DNA fragments, Bishkek test-tube process, IVF supplementary inspection items.
The test tube failed twice, should we continue to do it? The six types of supplementary investigation items are made clear at one time, and it is more important to take fewer detours.
I have done two test tubes and still have no pregnancy. Many people's first reaction is: Is the body "getting worse"? But from a medical point of view, this judgment is not rigorous. Two test tube failures do not mean that there is no chance, and it does not mean that the problem must be in a single link. The more common clinical situations are ovulation promotion, egg retrieval, fertilization, blastocyst formation, transplantation and implantation, and one or more links in this chain need to be rechecked. It is precisely because of this that the core of make-up inspection is not "the more you check, the better", but to find out the items that are really worth making up.
Let's start with the conclusion: after two test tube failures, priority is usually given to make-up inspection, not "mysterious inspection", but six basic and key projects. The first category is the assessment of uterine cavity and uterine cavity environment; The second category is embryo and chromosome related factors; The third category is the re-evaluation of sperm quality; The fourth category is endocrine and metabolic factors; The fifth category is the review of previous schemes and laboratory processes; The sixth category is the individualized investigation conducted by a few people under the judgment of doctors. This order is very important, because many people spend their time and expenses on projects with insufficient evidence, but delay the truly valuable adjustment.
Who needs more follow-up?
Not everyone who has finished the test tube twice has to check the project. People who need more systematic supplementary investigation usually include the following categories:
First, the two transplants were not implanted, especially the embryo quality did not look bad;
Second, once biochemical pregnancy, short-term implantation and failure;
Third, the woman is older and the number of embryos is limited, hoping to reduce trial and error again;
Fourth, the conventional margin of male semen is abnormal, or the previous fertilization rate and blastocyst formation rate are not ideal;
Fifth, there was a history of uterine cavity operation, polyps, hysteromyoma, adenomyosis, and thin intima.
The value of such people's make-up investigation is usually higher, because there are more identifiable reasons behind their failure.
The first category: uterine cavity evaluation, which is often a priority in the make-up survey.
If an embryo is like a "seed", then the environment of endometrium and uterine cavity is "soil". Intrauterine adhesion, endometrial polyps, submucosal myoma, uterine mediastinum, focal inflammation and other problems may affect implantation. Both ASRM's opinion on infertility evaluation and ACOG's document on hysteroscopy emphasize that uterine cavity evaluation is of practical significance in the investigation of fertility problems. Common methods include transvaginal ultrasound, saline infusion ultrasound and hysteroscopy when necessary. Especially after repeated failures, it is sometimes not enough to rely solely on ordinary B-ultrasound.
Expert tips
If the uterine cavity has not been systematically seen after two test tube failures, it is usually more valuable to make up a more targeted uterine cavity evaluation than to blindly replace the plan.
Many people will also ask, do you want to check chronic endometritis? This project is often mentioned in clinic, but it should be viewed objectively. ESHRE's document on repeated implant failures mentioned that the evaluation of chronic endometritis can be considered, but the diagnostic criteria and procedures still need to be standardized, and this conclusion should not be routinely applied to all failures. In other words, it belongs to "optional supplementary examination", which is more suitable for people with suspicious medical history, abnormal clues of uterine cavity or doctors' clear suspicion, rather than checking everyone at first.
The second category: embryonic factors depends on "whether it is necessary to make further judgment at the genetic level"
After two test tube failures, many people will immediately think of PGT-A. This idea can't be wrong, but it can't be mechanically applied. Embryo chromosome abnormality is indeed one of the important reasons for transplant failure and abortion, especially with the increase of the woman's age, the incidence of aneuploidy will increase. But the problem is that **PGT-A does not bring stable improvement to everyone. * * The ASRM Committee's opinion in 2024 pointed out that the existing evidence does not support it to benefit all patients; The evidence evaluation of NICE 2026 also believes that PGT-A is not suitable as a routine and universal add-on project.
Therefore, it is more reasonable to ask three questions first:
First, whether high-quality blastocysts were formed in the past two failures, or whether the quantity and quality of embryos themselves were not ideal;
Second, what range is the woman's age and ovarian reserve;
Third, whether there is a family history of hereditary diseases, repeated abortions or chromosomal abnormalities.
If the answer suggests that the risk at the embryonic level is high, there is more reason to further discuss PGT-related strategies than to regard it as a "standard remedial action".
The third category: the man should not only look at the semen routine, but also check it to a deeper level if necessary.
In reality, many couples still focus almost entirely on the woman after two test tube failures, which is inaccurate. Male factors not only affect the fertilization rate, but also may affect the quality of embryo development. AUA/ASRM male infertility guidelines emphasize that male evaluation should not only stop at one semen routine, but also combine medical history, physical examination, hormones and further examination if necessary.
As for the question "Do you want to check sperm DNA fragments?", the answer is not simply "both" or "none". ESHRE's suggestion on reproductive additional projects mentioned that the current evidence is not enough to support the detection of sperm DNA fragments as a routine project to predict pregnancy or directly guide treatment. In other words, it is more suitable for doctors to individually decide whether to make up the investigation in the situations of older men, repeated abnormal semen, poor embryo development and repeated failures.
The fourth category: endocrine and metabolism, not the more the better, but the basic items should be supplemented.
After two failures, thyroid function, prolactin, blood glucose metabolism, body weight, vitamin D status, ovarian reserve index, etc. often need to be looked at again. The reason is not mysterious: endocrine environment will affect ovulation quality, endometrial reaction and overall pregnancy environment. The key here is not to "convict" an abnormality once, but to the extent that intervention is needed, and whether the adjustment can make the next cycle more stable. ASRM also emphasizes that the evaluation of female fertility should be systematic and hierarchical, rather than a bunch of individual items.
The fifth category: the resumption of plans and processes is often more important than blind replenishment of projects.
This is the most easily overlooked step. Two test tube failures don't necessarily mean "more diseases", or it may be that the scheme doesn't match your real situation. For example, whether the ovulation-promoting reaction is too strong or too weak, whether the trigger timing is appropriate, whether there are problems such as low fertilization rate, low blastocyst rate, unsatisfactory selection of transplantation window, and inappropriate endometrial preparation method. In many cases, the real thing to do is not to continue to check, but to pull out the first two drugs, hormone changes, egg number, maturity rate, fertilization rate, blastocyst rate and transplant embryo grade completely.
Expert tips
After two test tube failures, it is often better to find the direction by arranging the complete medical records and laboratory data of the first two cycles according to the timeline than by directly adding the "immunization package".
Which tests are not recommended to be done routinely as soon as they come up?
This part must be made clear. After repeated failures, many people will be recommended to do a lot of immune tests, peripheral NK cells, various "implantation packages" and individualized endometrial receptivity tests. The problem is that the evidence of many of these projects is not stable. ESHRE's repeated planting failure document clearly mentions that many tests and treatments are not recommended for routine use at present; Among them, the detection of peripheral NK cells is clearly listed as one of the items that are not recommended to be done routinely. Similarly, some so-called "additional projects" also lack high-quality evidence to support their wide application.
Frequently asked questions
Q: Does the failure of two test tubes mean that the success rate will be very low in the future?
No. Two failures indicate the need for re-evaluation, but it does not mean that there must be no opportunities in the future. What really affects the next outcome is whether the cause of failure has been identified and whether the scheme has been adjusted.
Q: Do you want to change hospitals directly?
Not necessarily. First, let's see whether the original center is willing to make a complete resumption and whether it can explain where the failure occurred. If there is no clear analysis all the time, it is more reasonable to consider seeking a second opinion.
Q: Is the supplementary investigation as comprehensive as possible?
No. An effective idea in medicine is called "hierarchical investigation". Check the high-yield projects first, and then decide whether to do individualized check. Too many projects with insufficient evidence may increase anxiety and cost, but may not improve the outcome.
summary
Back to the original question: What tests do you usually need to make up after two test tube failures?
The more practical answer is: first, make up the intrauterine and endometrial environment assessment, embryo and genetic level judgment, male sperm re-evaluation, basic endocrine and metabolic examination, and complete re-examination of the first two cycles; As for immunity, NK cells and some additional tests, we should be cautious and not routine. The really effective next step is never to "check everything", but to find the key links that are most likely to affect your two failures, and then make targeted corrections.
From the point of view of clinical decision-making, the advantages of this path are closer to the real problem and can control invalid examination; The disadvantage is that it requires complete medical records, doctor experience and some patience, and there seems to be no illusion of "turning over immediately" in the short term. But if the goal is to make the next cycle more stable, this is a more reliable direction.
* * Confidence rating: high. * * According to the guidelines and opinions of the Committee mainly from ASRM, ESHRE, AUA/ASRM and NICE in recent years, the core conclusion is consistent: after repeated failures, priority should be given to systematic re-examination and supplementary investigation supported by evidence, rather than routine stacking and additional items.
Common aliases:Kyrgyzstan Tulip Reproductive Center, Tulip IVF, Tulip Reproductive Center, Tulip Hospital, Kyrgyz Tulip Reproductive Center, Kyrgyz Tulip Hospital
