Repetitive IVF Failure: Expert Shares Top Concerns And Facts
In spite of major advances in science and IVF technology in recent times, repetitive implantation failures still remains an enigma.
Repititive IVF failures can leave couples desperate for explanation
- Poor health and lifestyle factors can contribute to IVF failure
- Poor sperm quality can also be a reason
- A successful implantation also depends on the endometrial milieu
In Vitro Fertilisation has evolved into an assisted reproductive technique that is safe, efficient, and readily accessible. It has been established as a procedure that was considered to be a miracle in earlier years is now seen as the most viable solution for almost all fertility issues. This can largely be attributed to refinements in laboratory technology as well as the clinical practices. Though, over the years of clinical advancements, IVF has reached the success rates exceeding 50% which is witnessing a visible growth trend. However, at times, things do not always work out as planned and couples once in a while face repetitive IVF failures.
How repetitive IVF failures can affect you
Facing one or more unsuccessful cycles of IVF can be quite devastating and frustrating. When a couple fails to achieve pregnancy following transfer of at least four good quality embryos or after three embryo transfers, without any obvious underlying pathology, they are said to have recurrent or repeated implantation failure.
The success rate of reproductive treatment methods and commonly IVF depends on varied factors. Amongst which, the most important and discussed ones in the literature are maternal age, cause of infertility, the ovarian response to stimulation etc. Alongside which, the influence of the male factor (sperm quality), embryo quality and the various uterine pathologies also often contribute to the success. It is often speculated that in these couples, receptivity of the endometrium might also be a possible reason for the repetitive implantation failures.
Causes of repetitive IVF failures
1. Poor oocyte quality
A healthy egg helps in the development of a healthy embryo. Therefore, any abnormality in the egg might result in an embryo, which can be chromosomally abnormal. Egg after fusing with the sperm plays a major role in cell division and chromosomal replication to form an embryo. As the oocyte or eggs age, the spindle apparatus, responsible for the chromosomal separation and equal distribution, becomes prone to breakage. This often leads to an abnormal or anomalous distribution of chromosomes which can result in the formation of a chromosomally abnormal embryo.
With age, the free radicals or the reactive oxygen species in a woman's body increases. These free radicals present in her ovaries, often react with the residing eggs causing damage to its DNA and thus reducing its optimal quality.
2. Poor sperm quality
Abnormalities in the sperm may also lead to an unfertilized egg or chromosomally abnormal embryo. Considering the primary objective and role of sperm to produce an embryo, it becomes essential to identify the best quality sperm under high magnification during IVF for ensuring successful fertilization.
Due to certain environmental, genetic and lifestyle factors, morphologically normal sperms may also have a high fraction of abnormal or broken DNA which is reflected by raised DNA fragmentation Index ( DFI). This can also lead to problems in embryo development and consequently implantation failure.
3. Embryo quality
Embryos are morphologically assessed by microscopic examination and accordingly graded. Embryo quality plays an instrumental role in ensuring successful implantation. Even the morphologically normal embryo may contain abnormal genetic material which cannot be identified by routine microscopic examination. It is a natural function of the uterus to discard the embryos with any abnormality, which ideally means that the chromosomally abnormal embryo cannot survive and results in implantation failure or miscarriage. Therefore, alongwith the proper morphologic assessment, many compounding factors like parental age are of paramount importance for a successful conception. Advanced genetic testing on embryos can help to detect these genetic aberrations and improve embryo selection.
4. Uterine issues
A successful implantation also depends on the endometrial milieu. There are various structural, hormonal and immunological factors that affect an ideal uterine environment. Structural uterine factors such as the abnormal shape of uterus, fibroids, polyps, scarring and intrauterine adhesions can often lead to an implantation failure. These structural problems are usually identified early in the treatment and are corrected prior to embryo transfer. Persistently thin endometrium might also pose a problem and cause implantation failure. A healthy looking endometrium might not be receptive to a good embryo and hence cause implantation failure. Advanced genetic testing on the endometrium helps to identify the appropriate window of implantation and increase the chances of conception.
5. Health and lifestyle factors
Both paternal and maternal health play a role in successful conception through IVF. Consumption of alcohol, smoking, and drugs can elicit a lot of intricacies during implantation and pregnancy, which might lead to failure. Additionally, coexisting systematic conditions like diabetes and hypertension and unhealthy body weight also might result in recurring IVF failures.
Auto-immune disorders such as antiphospholipid syndrome and blood clotting disorders can equally lead to miscarriages. In spite of major advances in science and IVF technology in recent times, repetitive implantation failures still remains an enigma. There are many known and unknown reasons for RIF, and we do not have the tools to diagnose in each case the exact cause for the repeated failure. Repeated IVF failures is very frustrating for the couples undergoing IVF treatment and leaves them desperate for explanations. Genetic factors which are not visible on morphologic assessment of embryos and sonographic assessment of endometrium may be involved in such cases. Advanced genetic testing and appropriate psychological support may help these couples to some extent.
(Dr Manish Banker, Medical Director, Nova IVF Fertility)
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