If the treatment is unsuccessful, all patients should be given an opportunity to meet up with specialists to discuss the potential causes of implantation failure, correctable causes and offer remedy if any.

It is most frustrating and distressing when one encounters recurrent implantation failures particularly when good quality embryos were transferred. Apart from egg, sperm and embryo quality, the anatomy of the transfer pathway and the site of implantation can affect the chance of implantation.

Probable reasons for implantation failures:

• Less than optimum embryo transfer technique.
• Pathological lesions in the uterine cavity that prevents implantation.
• Presence of hydrosalpinges where toxic substances and fluid may back flow into the uterine cavity.
• Presence of obstructive fibroids that distort the endometrial cavity.
• Endometriosis known to affect egg quality.
• Poor embryo quality.
• Poor or abnormal embryo-endometrium interaction.
• Other abnormalities of the uterine cavity.

It is accepted that implantation rate is lower in older patients and those with high FSH. These women have diminished ovarian reserve and have shown to have increased risk of Down Syndrome. This shows that ageing oocytes are at higher risk of chromosomal abnormalities and malfunctions within the egg environment.

Patients undergoing IVF/ICSI should attain approximately 30% chance of conception. Research has shown that this rate does not change over the initial three treatment cycles but decreases considerably after four or more failed attempts.

The cumulative pregnancy rate differs significantly between women less than 35 years of age and those over 35 years. Conception rate also decreases significantly in both age groups when the number of retrieved eggs is less than 5.

Patients are often concerned about the risks of premature depletion of their ovarian follicle pool and cancer.

There is no evidence that ovarian stimulation diminish ovarian reserve. It is found that the number of eggs is maintained with repeated treatment attempts. However, it is evident ovarian response decreases with increasing female age. It is therefore advisable that couples in which the female's age is a pressing issue should undergo repeated treatment cycle without undue delay.

As for the fear of breast cancer, Veen et al; 1999 showed that the overall incidence of breast, ovarian and uterine cancer was no greater than expected incidence in the normal population.