Implantation Failure in IVF - Why It Happens?

The first IVF baby was born on the 25th of July 1978 and yet after all these years, scientists are still making huge efforts in order to improve the results of IVF. One of the main issues which still remains a challenge is recurrent implantation failures (RIF).

Repeated Implantation Failure (RIF) is defined as a failure to achieve a clinical pregnancy after transfer of at least four good-quality embryos in a minimum of three fresh or frozen cycles in a woman under the age of 40 years. If a treatment cycle is successful or not, it mainly depends on the embryo quality (both morphologic and genetic) and to a smaller degree on the endometrial lining (morphological criteria, thickness and timing between the lining and the embryo).

Chromosomal Abnormalities

As women age, the rate of chromosomal abnormalities in the eggs they produce and hence the
embryos they create increases. This leads to much lower success rates in older women and
higher miscarriage rates. In order to improve success rates, modern laboratories perform all
embryo transfers at the blastocyst stage and hence have the knowledge of the final assessment
of the embryo. Blastocysts have a lower chance of carrying chromosomal abnormalities, as
nature filters some of these, as the embryo develops post fertilization. In cases where the
expected cause of the RIF is suspected to be embryonic, then a Karyotype blood test on both
partners is requested, to exclude additional genetic factors that may lead to a higher than
expected percentage of abnormalities in the embryos they produce. Preimplantation genetic
screening of the embryos at the blastocyst stage may also be recommended, depending on the
medical history and the expected number of blastocysts.

Structural abnormalities of the uterus

Structural abnormalities of the uterus may also lead to failed implantations. These may include
any pathological alterations in the endometrial cavity such as hyperplasia, the presence of uterine septa, submucous fibroids and polyps. Furthermore, chronic endometritis may affect how the endometrial lining develops and also leads to failed implantations. The presence of a
hydrosalpinx or endometriosis, may also affect the chances that one has to succeed in an IVF
treatment. Structural abnormalities can be detected through non-invasive 3-dimensional
ultrasound scans. In certain cases, more invasive procedures like a Hysteroscopy or
Laparoscopy may also be required both to investigate but also to treat occurring conditions.

Endocrinological factors

Endocrine factors may also be responsible for increasing the risk of an implantation failure. This
includes thyroid disease, diabetes mellitus, and luteal insufficiency. Available data suggest that
subclinical hypothyroidism, defined as TSH above 4mIU/L, is also associated with miscarriage
and that treatment improves pregnancy rates.

If implantation fails to occur even if all the above-mentioned methods and tests have been
completed then, alternative methods should be explored. If the likely source of the problem is
embryonic, then the couple in some cases may even need to consider gamete donation. If the
problem is caused by uterine factors and the issue may not be resolved then surrogacy should
be considered.

In conclusion, there are many factors involved in IVF treatments that may lead to repeated failed
implantations. However, there are also many ways to investigate the causes and there are
solutions to many of these problems. Individualized treatment protocols and suggestions are
required for each patient and depending on the reasons behind the failures they have faced.

The medical and scientific team at Newlife IVF Greece never stops expanding their knowledge
and work hard on offering the most up-to-date treatments and solutions available in the IVF
sector.

However, apart from offering their experience and guidance medically they are also here
to listen and help you deal with all aspects of your treatment. You can fill in our
contact form so we can offer a free medical consultation in order to discuss your case, answer
all your questions and join you in your IVF journey.