Preimplantation genetic testing of the embryos that can be performed with in vitro fertilization should be considered in order to confirm that an embryo is chromosomally normal before it is transferred back into the uterus.
Further evaluation of the uterus with a surgery called hysteroscopy may be warranted. There are new tests that can be used in the setting of frozen embryo transfers that allow us to personalize the endometrial preparation to enhance endometrial receptivity and improve implantation. Most first trimester miscarriages occur before weeks, but are sometimes not recognized until a few weeks later.
Risk Factors for Miscarriage The likelihood that you will miscarry is greatly influenced by your age. There are other risks of miscarriage including previous miscarriage, extremes of weight, the use of toxic substances like cigarettes and moderate to high alcohol consumption. There is some data that suggests untreated celiac disease may increase the chance of miscarriage. Uncontrolled endocrine issues, such as thyroid and diabetes can increase the miscarriage rate.
I think of it like a symphony of the genes being turned on and off at specific times. If the timing of this is off, just like an orchestra, things will go badly. Basic science studies suggest that energy function metabolism of the embryo is also a likely cause of failure, but this too cannot be practically measured in the clinical lab.
Basic science studies and our clinical experience suggest that early embryo development can be altered by our clinical and laboratory environment. It is clear that the type of follicular stimulation in an IVF cycle will impact the oocyte and embryo.
The correct use of supporting medications LH or low dose-hCG, growth hormone, androgens may be beneficial to development of the growing follicle and egg for some individuals. However, incorrect use of these medications can be detrimental. The type of trigger shot used to prepare for egg retrieval hCG or GnRH agonist may have an impact on egg quality also, but who may benefit from which drug and to what degree there is an advantage remain unclear.
As you can imagine, the laboratory environment plays a huge role in how the embryos will perform. Culture media has evolved tremendously over the last 30 years, starting from simple media adequate for most cells to the variety of high quality embryo-specific, commercially made media that we currently use.
There are several high quality culture media available that work well however, constant quality testing is essential to make sure a chosen media performs optimally.
The incubators that the embryos grow in and their function are clearly a major factor. Most high quality practices are using the small bench top incubators which do a better job of maintaining the chemical environment and temperature stability for the embryos to grow in. However, these high-tech devices must be constantly monitored, as subtle changes can impact embryo performance. Simple things like how often the embryos are evaluated, under what conditions, and the time it takes to do so can tremendously impact embryo performance.
The trend is clearly towards evaluating the embryos less frequently. It should not go without saying that technical competence of the people in the laboratory is essential for good outcomes. However, those of us who have done inspections have seen a wide array of skill levels. In ICSI intracytoplasmic sperm injection- injecting the sperm in to the egg for example: was the procedure done at the correct time? What kind of sperm was selected? Was the sperm inserted in the correct place in the egg?
How long was the oocyte egg out of the incubator? Embryo biopsy for testing the chromosomes is a very demanding technique that requires a great deal of practice and experience. Vitrification very rapid freezing of embryos and eggs has been a huge benefit to us, but the technique is subtle and not everyone gets the same results. Clearly, monitoring of laboratory personnel is vital to a high quality embryology laboratory.
Quite honestly, the uterus is my best friend on a day-to-day basis. That is because it usually works. I say this because over the last 26 years, I have seen large numbers of sub-optimal appearing embryos make beautiful children.
They were suboptimal often because of patient parameters, but also because our treatments and our labs were less sophisticated, and the uterus rescued them. But there are clearly uterine issues that contribute to failure, some of our creation. Structural Problems. Uterine structural defects are frequent problems, but these are usually found and corrected prior to treatment.
However, when IVF failures do occur, it must be accounted for. He can be contacted at info drmalpani. Karande Dr. Klipstein Dr. Puscheck Dr. Schedule an Appointment With Us. Aniruddha Malpani Feb 19 Comments. It's not your fault Sound familiar? What is implantation failure in IVF? Which is the culprit — the seed or the soil? There are three main reasons for this happening: Poor seed quality embryo Soil which is not fertile uterus The environment is not conducive enough physical health of the mother-to-be In rare cases, additional factors which prevent growth include improper seeding difficult or traumatic embryo transfer , or a sudden change to the environment e.
How does embryo quality impact successful implantation? Role of endometrium in embryo implantation The importance of soil quality in agriculture is well known. We still don't completely understand implantation Human embryo implantation is an enigmatic biological phenomenon — after all, in-vivo experiments are impractical and unethical to conduct; and studies with animal models do not translate well to humans.
If the uterus contains adhesions, polyps or fibroids in the cavity, then its receptivity will be impaired. This can lead to failed implantation. This problem can be solved by careful monitoring of the IVF cycle. It is believed that thin endometrial lining a lining which is less than 8mm is not receptive enough. An infection of the uterus has also been hypothesized to prevent implantation, by making the uterine environment less optimal.
What factors other than the embryo and uterus might contribute to implantation failure? Can implantation failure be treated? What evidence-based therapies are available? The following therapies do not have solid proof for their efficacy and are very speculative: Use of blood thinners like aspirin and heparin. Causing local injury to endometrium before embryo transfer, to improve local uterine blood flow. Use of embryo glue a substance which is claimed to enhance the attachment of embryo to the uterus.
Routinely making a hole in the zona pellucida of the embryo outer coat of the embryo with the aim of helping the embryo to hatch out of the shell successfully. This is known as laser assisted embryo hatching. Co-culturing embryos with endometrial epithelial cells. What can I do if I have repeated implantation failure? Do you have good ovarian reserve? If you have poor ovarian reserve or are older than 40 years of age and have suffered repeated implantation failure, you should consider using donor eggs.
If you are young and have good ovarian reserve, ask the embryologist how your embryos look — are they of good quality? If they are of good quality dividing well according to their age , then the chances are that the embryos which were transferred may have been genetically normal sadly, we still do not have the technology to test for all possible genetic defects before the transfer. Do you have PCOS? Did they retrieve lots of eggs more than 25 eggs from your ovaries?
PCOS could be a reason for the lack of embryo implantation. Taking insulin sensitizers like metformin and myoinositol might solve your problem. If your doctor has used the same ovarian stimulation protocol for retrieving eggs from your ovaries, you can try other ovarian stimulation protocols too. Mild ovarian stimulation protocols are found to be superior in producing better quality eggs and embryos in a selected subset of IVF patients mostly patients with poor ovarian reserve.
If you have failed IVF several times by using a day 3 embryo transfer, try having a day 5 embryo transfer. The fact that embryos are developing to blastocyst stage is a good indication not an ultimate proof though that your embryos are good enough.
You can try doing a frozen embryo transfer instead of a fresh transfer. High levels of estrogen in the body during a fresh cycle can damage uterine receptivity. If you have cervical stenosis and embryo transfer through cervical route becomes difficult you can try other modes of embryo transfer like ZIFT You can try changing the clinic — sometimes this works! Another option available is to use donor eggs or donor embryos.
If your uterine cavity contains adhesions, polyps or fibroids, you need to remove these.
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