Repeated Implantation Failure
What is Repeated Implantation Failure?
Repeated implantation failure refers to the failure torepeated implantation failure achieve pregnancy in an IVF cycle
after transfer of at least three to four good-quality embryos in a minimum of three fresh or frozen cycles in a woman
under the age of 40 years.
Successful IVF, IVF-ICSI is good procedures, but still in some cases in spite of repeated attempts with good embryos
the procedure is not successful.
Successful embryo implantation requires synchronous development and interaction between the embryo and the endometrium.
Recurrent implantation failure causes a lot of mental and financial stress on the infertile couple. It is also very
difficult for the treating doctor to explain the reasons for not being successful in spite of everything being right.
RIF may be both of embryonic or uterine factors or both.
Repeated Implantation Failure (RIF) may be due to several causes:
Congenital uterine abnormalities, such as endometrial polyps, uterine fibroids, adhesions, hydrosalpinges, endometriosis,
Male factors such as severe oligoasthenozoo-spermia with increased sperm DNA fragmentation may also impact on
the grading of the embryo.
Aneuploidy in embryos
Metabolic disorders like uncontrolled diabetes, impaired thyroid function or prolactin level, etc. in the couple
Thrombophilias or antiphospholipid syndrome
Impaired endometrium: Impaired endometrium can be a common cause of recurrent IVF failure. When morphologically good
embryos are transferred, the question arises as to whether the problem is due to incompetent embryo or endometrium or
If the patient is young and there are morphologically good embryos then there is a greater chance that the problem lies
with endometrium, either in terms of thickness, character, vascularity or immunology.
For successful implantation to occur, there are several chemical signals between the embryo and endometrium.
Maternal blood tests
Clotting factors – Small clots in the blood have been identified as a possible cause for pregnancies failing to progress.T hese patients can be treated with aspirin or low dose heparin.
Immunologic factors – High levels of uterine natural killer cells and auto-antibodies can also be the cause for RIF.
Hysteroscopy or endometrial scratching results in decidualization. There is some evidence that these procedures if done in
the cycle before ovarian stimulation and IVF/ET increase the pregnancy rate in RIF patients.
Endometrial Receptivity Array
For a short period of time during the menstrual cycle after the embryo reaches the uterus, the receptivity to welcome
embryo is called endometrial receptivity. This lasts for a short period and is called window of implantation (WOI).
ERA is a reliable test to determine the time of window of implantation for any female and helps in personalized embryo
transfer for patients in RIF for increasing the success rate of implantation.
Genetic screening– Preimplantation Genetic Screening (PGS) assesses for the presence of all the chromosomes of the embryo (complete chromosomal karyotyping) and can help us to select the most “competent” embryos for transfer.
Time-lapse imaging– allows assessing subtle changes seen during embryo development and identifying the best embryos for
Laser-assisted hatching– is a physical or chemical treatment carried out immediately before embryo transfer. The idea is
to weaken an area of the zona pellucida with the aim of improving the chances of implantation.
The aim of the treatment should be such as to increase the chances of implantation and pregnancy. Effort should be made to
increase the receptivity of endometrium and improve the quality of embryos. People have used immunomodulators to increase
the receptivity of endometrium, scratching of the endometrium, PRP instillation and autologous stem cells. Intravenous
injection of IgG is used to suppress immune responses in order to improve live birth rates.
If nothing works, the couple should be advised to go for surrogacy.
Do you want to discuss all your infertility problem with us? Delhi-IVF has a forum where we can discuss all about
assisted reproductive technology over a cup of coffee.