What are the causes of recurrent implantation failure? - Dr. Usha B R

Recurrent implantation failure is when good quality embryos were transferred uneventfully on two different occasions but still failed to result in a pregnancy, the causes could be various it is a known entity and it is seen in 10% of the individuals going through an IVF program. What are the causes? The causes are either associated with embryo or associated with uterus. What are the embryo causes? Embryo is formed from the egg and sperm . The causes could be related with the egg where you have an abnormal egg resulting in an abnormal embryo or it could be a defective sperm resulting in an abnormal embryo. How do we tackle this? We test the couple for any karyotypic abnormalities. If they are normal, then we test the embryo itself , what we call as preimplantation genetic testing, what we call as aneuploidy. Those embryos which are genetically found to be normal, only those are transferred. So in that way this problem can be overcome. The other causes associated with the uterus could be fluid in the tubes or there could be fibroids or there could be septa inside the uterus or there could be adhesion inside the uterus. A simple hysteroscopy prior to the procedure will be able to or associated with laparoscopy will be able to diagnose most of these conditions. Another important cause is thrombophilia, where there is excessive clot formation in the vessels which carry the blood in the uterus this excessive clot formation will not allow the embryo to grow. So we use blood thinners in this situation like ecospirin or low molecular weight heparin, which will help top improve the pregnancy rates another important thing when you have thin endometrium and known cases of tuberculosis and in such cases also implantation failure is seen. In other cases we also do certain procedures like endometrial scratching or what we call as coring to improve the implantation rates.