Repeated Implantation Failure Causes And Treatment

Repeated Embryo Implantation Failure: Causes and Treatment

Summary

Repeated implantation failure means that pregnancy has not occurred after several transfers of good-quality embryos. The cause is most often in the embryo itself, less often in the uterus, and sometimes in the general health of the couple. A careful review of the previous cycles and a small number of targeted tests usually show what can be changed. Many couples go on to have a baby once the cause is treated or the plan is adjusted.

What is repeated implantation failure?

There is no single definition. Doctors commonly use the term when a woman has not become pregnant after three or more transfers of good-quality embryos, or after fewer transfers when the embryos were genetically tested and normal. Age matters: the number of failed transfers that should raise concern is lower in a young woman with good embryos than in a woman over 40, in whom failed transfers are more often explained by the eggs.

It is different from recurrent miscarriage, in which pregnancy starts and is then lost.

How implantation happens

For pregnancy to begin, a healthy embryo must reach a receptive lining of the uterus at the right time, attach to it and grow into it. A problem with the embryo, the lining, the timing or the environment around them can stop this step.

Causes

1. The embryo

·       Chromosome errors in the embryo are the most frequent cause. They become more common as the woman’s age rises, and an embryo can look good under the microscope and still be abnormal.

·       Egg quality, affected mainly by age and sometimes by conditions such as endometriosis.

·       Sperm quality, including damage to sperm DNA.

·       Rarely, a chromosome rearrangement in one of the parents.

2. The uterus

·       Polyps, fibroids that bulge into the cavity, adhesions or a uterine septum.

·       Hydrosalpinx: a blocked, fluid-filled tube whose fluid leaks into the uterus and lowers implantation.

·       Chronic endometritis: a mild, long-standing inflammation of the lining, often without symptoms.

·       A thin lining that does not thicken enough before transfer.

·       Adenomyosis, in which the lining tissue grows into the muscle of the uterus.

3. Timing and technique

·       The lining is receptive for only a few days; if progesterone is started too early or too late for the embryo’s age, the two are out of step.

·       A difficult transfer.

4. General health

·       Smoking, excess weight, uncontrolled diabetes or thyroid disease, and high prolactin.

·       Antiphospholipid syndrome, a clotting disorder linked to failed implantation and miscarriage.

·       Low vitamin D may play a part.

5. No cause found

In some couples all tests are normal. This is frustrating, but it does not mean the next transfer will fail; many succeed with a further attempt.

Tests your doctor may advise

·       A detailed review of earlier cycles: the stimulation used, the number and grade of embryos, the day of transfer and the lining thickness.

·       Hysteroscopy or 3D ultrasound to examine the cavity of the uterus.

·       Ultrasound or a tube test to look for hydrosalpinx.

·       A sample of the lining to look for chronic endometritis.

·       Blood tests: thyroid function, prolactin, blood sugar, vitamin D and antiphospholipid antibodies.

·       Chromosome analysis (karyotype) of both partners.

·       Semen analysis and, in selected cases, a sperm DNA fragmentation test.

Not every couple needs every test. Dr. Layyous chooses them according to your history.

Treatment

Treating what is found

·       Removal of polyps, submucous fibroids, adhesions or a septum by hysteroscopy.

·       Removal or closure of a hydrosalpinx by laparoscopy before the next transfer.

·       A course of antibiotics for chronic endometritis, with a repeat check if needed.

·       Correction of thyroid, prolactin, sugar and vitamin D; stopping smoking and reaching a healthier weight.

·       Blood-thinning treatment (low-dose aspirin and heparin) when antiphospholipid syndrome is confirmed.

Improving embryo selection

·       Growing embryos to day 5 (blastocyst) before transfer.

·       Genetic testing of embryos (PGT-A) in selected couples, to avoid transferring embryos with chromosome errors.

·       Advanced sperm selection methods when sperm DNA damage is suspected.

Improving the lining and the transfer

·       A different preparation of the lining, often with a frozen embryo transfer in a carefully timed cycle.

·       Adjusting the timing or dose of progesterone.

·       Transfer under ultrasound guidance.

Treatments with limited evidence

Several additional treatments are offered worldwide for repeated implantation failure: endometrial receptivity testing, scratching of the lining, platelet-rich plasma (PRP) to the uterus, embryo glue, assisted hatching, and immune treatments such as steroids, intralipid or immunoglobulin. Studies so far have not shown clearly that they increase the chance of a baby for most couples, and some carry risks or costs. They may be considered in selected cases after discussion with your doctor; they are not routine.

What you can do

·       Stop smoking, and avoid alcohol.

·       Aim for a healthy weight and keep active.

·       Take folic acid, and vitamin D if your level is low.

·       Ask for your full records from previous cycles and bring them to your appointment.

·       Look after your emotional health; repeated failure is exhausting, and support helps.

Frequently asked questions

Does bed rest after transfer help the embryo implant?

No. Studies show no benefit from bed rest; normal light activity is fine.

Did I do something to cause the failure?

Almost never. Implantation depends mainly on the embryo and the uterus, not on what you did in the days after transfer.

How many times should we try?

There is no fixed number. The decision depends on your age, the embryos obtained and what the tests show. Dr. Layyous will give you an honest view of your chances before each attempt.

When to see the doctor

If you have had two or more unsuccessful transfers of good embryos, ask for a full review before trying again. You can begin by sending your reports on WhatsApp: +962 78 048 6388.

This article is for general information and does not replace a medical consultation.