Implantation Failure Causes and Treatment

Some infertile couples undergo many IVF cycles and produce good quality embryos but the embryos consistently fail to implant. This is called Implantation Failure (IF). The process of implantation involves two main components, a healthy embryo that should have the potential to implant and a receptive endometrium that should enable implantation.

Maternal: Inadequate endometrial receptivity (65% of IF): IF might be due to undiagnosed uterine pathology mainly hyperplasia, polyps, endometritis, synechiae or fibroids. Decreased endometrial receptivity could be because of thin lining, altered expression of adhesive molecules, immunological factors or thrombophlias.

Embryonic: Genetic & chromosomal cause (30% of IF): High rate of chromosomal abnormalities in human embryos is responsible for IVF failure in majority of cases.

Multifactorial: (5% of IF): Patients with endometriosis have decreased ovarian response, embryo quality, implantation & pregnancy rates which may cause implantation failure.

Hydrosalpinx lower implantation and pregnancy rates by direct embryo toxicity or adverse effect on endometrium.

Investigation & Treatment for Implantation Failure

Improving Endometrial Receptivity:

Studies have shown that hysteroscopic treatment of intrauterine pathologies improves the pregnancy outcome.

With the advent of Endometrial Receptivity Array (ERA) test, it is possible to screen the human endometrium for its receptivity status in natural and stimulated cycles. It is a molecular diagnostic tool that can identify whether the endometrium is receptive or not by analysing the expression of a group of 238 genes related to endometrial receptivity. The ERA test has shown that some of the WOI allows the personalisation of the embryo transfer.

Selection of Good quality Embryos:

Time Lapse Imaging: The newly developed proceure ascertains the optimal embryos for transfer into the womb based on the amount of time that the fledging embryos takes to grow from one stage to another stage. When this defined time period lasts longer, the embryo is probably carrying an abnormal number of chromosomes (called aneuploidy), which will inevitably result in a failed pregnancy.

PGS/PGD: PGS is a preventative measure used to identify chromosomal abnormalities in the embryo, even if there is no evidence of a genetic abnormality in either parent.

Transfer of embryo at the blastocyst stage is a more physiological approach because the human embryos enter the endometrial cavity only 5 days after fertilization.

Improved embryo transfer technique must be done very carefully and gently in cases of implantation failure.

Multifactorial Treatment Options

Literature has shown that suppressing endometriosis before planning ART significantly increases the clinical pregnancy and ongoing pregnancy rates.

Laparoscopic salpingectomy is recommended in all women with hydrosalpinx before IVF treatment, definitely in cases of implantation failure.

At Akanksha IVF center we have many patients of implantation failure referred from other centres. Our team comprising experienced specialists and embryologists is well equipped to handle such cases with good and convincing results.