Recurring Implantation Failure
Patients who have undergone multiple IVF cycles including embryo transfers, but who still do not get pregnant are said to have Recurrent Implantation Failure. This could either be because of poor embryo quality or the endometrial receptivity.
Unfortunately, sometimes embryos that grow well initially stop growing later. This is likely to happen because of some inherent genetic defects in those embryos. Hence, some of the embryos that despite looking healthy in the laboratory will stop growing after they are transferred to the womb. This is a reason for IVF failure in large majority of cases.
Thin lining of the uterus (endometrium) or insufficient blood supply in the uterus can affect implantation. Hormonal imbalances are also sometimes responsible to put the uterus out of phase for receiving the embryo.
The range of treatments to counter this are:
Most of embryo transfers are performed on Day 3. When an embryo is cultured in the lab for 5 to 6 days it forms a blastocyst. Blastocyst culture allows for better selection of the embryos to be transferred and allows for lesser number of embryos to be transferred to achieve a pregnancy. Thus the risk of multiple pregnancy is reduced. Not all embryos will develop to blastocyst stage and at times no embryos or fewer embryos will be available for freezing.
An embryo is transferred into the womb on Day 3 followed by a blastocyst transfer on Day 5. This improves the pregnancy rate.
Frozen embryo transfer
Instead of transferring an embryo in a fresh cycle, all embryos are frozen and transferred later in a freeze-thaw cycle.
G-CSF (Granulocyte - Colony Stimulating Factor) Filgrastim
G-CSF may increase endometrial thickness in the small group of patients who otherwise would opt for cycle cancellation or surrogacy.
LASER assisted hatching
This is a technique where a gap is made in the outer shell or "zona pellucida " of the embryo prior to the embryo transfer. This helps the embryo hatch and promotes implantation of the embryo in the uterine wall after embryo transfer.
Endometrial Scratch Technique
This can improve the receptivity of the uterus and implantation chances. It stimulates tissue remodeling that cause’s local release of factors that promote implantation.
This can be performed to assess the uterine cavity and correct any abnormality to improve the implantation rates in the subsequent cycle.
In case of thin endometrium in the previous failed IVF cycle or repeated implantation failures, an endometrial biopsy can be done before the stimulation cycle.
Endometrial Receptivity Array
ERA is a test to determine at what point in time the endometrium is most receptive for a successful embryo transfer.
Low dose Aspirin, Low Molecular Weight Heparin and Steroid Support.
This may be used as adjuvant therapy. It is commonly used in the management of recurrent miscarriages
Estrogen and Estrogen and sildenafil medication
This can also be used to improve blood flow in the womb, to improve the chance of implantation
It is believed to enhance endometrial receptivity but the scientific evidence is lacking.
PRP (platelet-rich plasma) is used effectively for endometrial growth in patient with thin endometrium.
This can help determine and treat the cause of early implantation failure.
Immune therapy can be used in a select group to improve success.
Karyotyping (Chromosomal Analysis) of both partners can help determine genetic cause of failed fertilization or early repeated miscarriages.
Donor eggs can be used to maximize success rates in cases of repeated IVF failure due to poor egg quality or in women with poor ovarian reserve and premature menopause.
Donor sperms can be used in case of repeated failures of ICSI which was done for issues with sperm quality.
Donor embryos can be used in case of both eggs and sperms being of poor quality.
It is recommended when there are repeated implantation failures owing to poor quality of endometrium or other problems in the uterus.