Infertility becomes one of the biggest lifestyle problems in the global world today. Most couples suffer from this issue and seek fertility treatment at various fertility clinics. The treatment of infertility in couples has increased rapidly in recent years. Assisted Reproductive Technology (ART) cycles are performed all over the world to combat infertility in intending parents. Ovarian stimulation, suboptimal laboratory culture conditions and various faults in embryo transfer techniques cause failure in conception and pregnancy. This results in low pregnancy rate (PR) in women. People with high pregnancy and delivery rates suffer from repeated implantation failure (RIF) that delays pregnancy. This article aims to summarize the reported aetiologies for RIF for a better understanding of the intended parents.
Understanding RIF – Is it Normal?
Out of every 10 high-grade embryo transfers 2 to 6 of the IVF cycles do not achieve success in the first three attempts. As per the recent treatment trend of infertility one or two embryos are transferred at a time. It is normal for women under the age of 40 to experience a maximum of 3 failed attempts while women over the age of 40 can experience up to five or six times of failed IVF cycle. This failure is considered to be normal in IVF treatment procedures as there are multiple unexplained reasons for failed attempts. In case there are more attempts of failures recorded in the treatment procedure, a detailed investigation is required to find out the accurate reason for that.
Multi-factorial Causes Of Repeated Implantation Failure
Endometriosis is the prime cause for Repeated Implantation Failure in women. Apart from Earth ovarian response and the quality of embryo also contributes to the reason. Patient suffering from hydrosalpinges are also reported to have lower implantation. A commonly known fluid with a slightly alkaline base that contains cytokines, prostaglandins or other inflammatory compounds is known as Hydrosalpinx. The compounds have direct embryo-toxicity and sometimes those adversely affect the endometrium during conception. The reflux of hydrosalpinx fluid into the uterine cavity also causes reduced embryonic endometrial apposition.
The quality of the embryo and endometrial are important elements that are affected by certain drugs given for ovarian stimulation. It is evident from various trials of IVF cycles that RIF is a normal phenomenon to occur in any pregnancy program. Intended parents should not feel confused or depressed due to search failures in implantation. On rare occasions, the implantation is successful in the first two attempts. It has been noticed in the past that women with no implantation issue at such have also faced RIF due to unknown reasons.
Methods for Treatment of Repeated Implantation Failure (RIF)
Improving endometrial receptivity can be an effective way to correct RIF. The following ways are implemented for that.
- Treatment of thin endometrium
- Hysteroscopic correction of cavity pathology
- Immunotherapy (intravenous immunoglobulin, steroids, aspirin, and heparin)
- Endometrial stimulation (biopsy)
Treatment of the embryos is another important method to treat RIF. It is done in the following ways mostly.
- Assisted Hatching
- Zygote intra-Fallopian transfer
- Cytoplasmic transfer
- Improving ET technique
- Preimplantation genetic screening
- Blastocyst transfer
- Multi-factorial Treatment Options
- Salpingectomy in case of hydrosalpinges
- Psychological assistance
- Treating endometriosis
- Tailoring the stimulation protocols
How to Handle Uncontrolled RIF
Some IVF cycles suffer from uncontrolled RIF. Due to various inabilities or deficiency of the embryo the pregnancy cannot be achieved. IVF has a solution for such a problem as well. Egg donation is introduced in the IVF cycle to support the pregnancy. High-quality eggs are derived from professional egg donors and used in the formation of a healthy embryo. Surrogacy is another vital option that can be taken up to overcome the issue of Repeated Implantation Failure (RIF).