Repeated Implantation Failure

Nakshatra Clinic

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Repeated Implantation Failure

Overview

At the time of transferring embryos with the help of In Vitro Fertilization when the embryos fail to get transplanted, it can be then considered as the Implantation Failure. Repeated Implantation Failure similarly can have no formal criteria describing the number of failures that happened in the transferring process of embryos in the IVF cycle.
Moreover, there are several definitions related to the number of RIF while ongoing IVF. According to research, it is considered that 1-2 embryos of good quality fail to get transferred in every cycle of IVF of at least three continuous attempts is defined as the RIF.
Successful implantation also requires the presence of the mother as a host and the presence of the embryo. Furthermore, successful Embryo implantation may depend on the endometrial functionality including a normal healthy embryo. In simple terms, when this gets disturbed because of the defectiveness in the variable the RIF can be diagnosed.

About Repeated Implantation Failure

Repeated Implantation Failure

There are several causes that can hamper the Implantation process causing RIF. Several problems like abnormal uterine anatomy, non-receptive endometrium, and the medical condition including thrombophilia and abnormal immunologic response present in the host can rigorously affect the connection between the embryo and endometrial.
Unlike the above situation, the endometrial–embryo interaction may be further hampered with the destruction of the embryo. The abnormality of the embryo can be possessed in an embryo from either the parental sperm factors or from the oocyte.
Several other causes of Repeated Implantation Failure are further described below for your better understanding:

  1. Embryonic Problems
      • Chromosomal and Genetic Abnormalities
      • The Problem of Embryo emerging from the Zona Pellucida (Enveloping Layer)
  2. Uterus Problems
      • Anatomical alterations
      • Benign tumors (fibroids)
      • Scarring, adhesions, or synechiae
      • Infections or inflammation

There are several cases where a woman might not face any symptom with the failure of the RIF, but some women may face the following situations:

  • Persistent Pelvic Pain
  • Obstruction in the Bowel
  • Painful menstruation
  • Suffering at the time of performing sexual Intercourse
  • Infertility
  • Increased occurrence of ectopic pregnancy

According to the study, the researchers prefer a vaster and broader definition and diagnosis of the RIF if found two consecutive failures in the attempts. It is also considered by the researchers that the main factor should be regarding the quality and number of transferred embryos.
Previously several earlier Meta-analyses focused on the efficacy controlling of the single therapeutic intervention for RIF with patients of at least two past failed ET attempts. Moreover, by following these conditions, the amount of false-positive RIF’s diagnosis rate is thought to be considerable of at least 46% and, as an outcome, the examined inhabitants are as likely as not included as the noteworthy number of patients without a real barrier to fertilization.
In addition, who had not yet achieved success just because of statistical misfortune? Furthermore, researchers provide evidence about the success of therapeutic interventions obtained from Meta-analyses conducted with these thoughts cannot, therefore, be considered completely valuable and trustable.
In the current organized review and meta-analysis, further, it can be derived that the RIF is the failure to achieve a clinical pregnancy after at least three ET attempts. This threshold further minimized the risk of false-positive diagnosis at a significantly lower rate. This diagnostic benchmark also disbars the elements of subjectivity and therefore it is highly important and easily replicable in any clinical setting.

Several Therapies and medications to cure the problem of RIF are further listed below and can be broadly divided into 4 following parts:

1. Uterine Medications
Uterine Medication can be performed by a doctor when an international endometrial injury can be spotted including hysteroscopy. This form of medication also includes endometrial sampling for histology and microbiological investigations and endometritis treatment; atosiban administration; copper intrauterine device placement.

2. Laboratory and Procedural Technologies and medications
This further includes the sequential ET process where the ET medium is enriched with hyaluronic acid that is further provided by the doctor. The doctor also looks into some other factors to perform the Laboratory and Procedural Technology. Moreover, the process includes things like autologous embryo-cumulus cells co-culture relation including intracytoplasmic morphologically selected sperm injection (IMSI); blastocyst stage ET; zygote intrafallopian tube transfer (ZIFT); assisted hatching (AH); preimplantation genetic testing for aneuploidies (PGT-A)).

All the above techniques can be valuable and can provide good results if performed by a good and experienced doctor.

3. Immunomodulatory Therapies
Performing Immunomodulatory Therapy can be daunting and this needs a good efficiency of doctors as well. To perform the Immunomodulatory Therapy some basic things are also performed by the doctor that further includes the intravenous immunoglobulin (IVIG); intrauterine peripheral blood mononuclear cell (PBMC) infusion; tacrolimus; subcutaneous or intrauterine granulocyte colony-stimulating factor (G-CSF) administration; intrauterine autologous platelet-rich plasma (PRP) infusion; intravenous intralipid; intrauterine human chorionic gonadotropin (hCG) injection; low-molecular-weight heparin (LMWH); aspirin; prednisolone)

4. Endometrial Receptivity
This is the final process related to treatments glorifying the endometrial receptivity or technologies. This, in addition, is performed by the doctor to identify the endometrial gap window of Implantation (WOI). For instance, the trimascular growth hormone (GH), vaginal sildenafil; endometrial receptivity array (ERA) are some good examples of this strategy.