Causes and treatment : Implantation failure (IF) in IVF

IVF Failure Treatment

Implantation Failure(IF) 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 should have the potential to implant.
A receptive endometrium 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 thrombophilia

Embryonic: Genetic & chromosomal cause (30% of IF): High rate of chromosomal abnormalities in human embryos is responsible for IVF failure in the 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 embryotoxicity or adverse effect on the endometrium.

Investigation & Treatment for Implantation Failure

1. 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 analyzing the expression of a group of 238 genes related to endometrial receptivity. The ERA test has shown that some of the WOI allow the personalization of embryo transfer.

2. Selection of Good Quality Embryos:

Time Lapse Imaging: The newly developed procedure ascertains the optimal embryos for transfer into the womb based on the amount of time that the fledging embryos take 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.

3. 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 with implantation failure referred from other centers. Our team comprising experienced specialists and embryologists is well-equipped to handle such cases with good and convincing results.