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IVF Failure

Introduction

In Vitro Fertilization (IVF) is an Assisted Reproductive Technology, used in the treatment of Infertility. This involves taking out of the eggs from the ovaries, and fertilizing them with sperms in the laboratory. The pregnancy grows in the laboratory for 2-5 days and then it is transferred into the uterus. The success rate of IVF is 40-50%.

For the success of IVF procedure, the pregnancy has to get implanted successfully into the inner lining of the uterus (endometrium). Implantation of pregnancy is a complex process and requires a synchronous development and interaction between pregnancy and endometrium. Clinically implantation is successful when a gestation sac is seen on ultrasonography.

Causes of IVF Failure

  • Defects in the embryo – Genetically abnormal embryos
  • Implantation Failure – Embryo is unable to get implanted into the endometrial lining

What is Implantation Failure?

Implantation failure is a term used when there has never been evidence of implantation, hCG not detectable, or when there is evidence of implantation, detectable hCG, but it does not respond to the formation of a gestational sac visible on ultrasonography . Recurrent  Implantation failure is an important cause of Recurrent IVF Failures.

Causes of Recurrent Implantation Failure

The implantation failure can be due to

  • Thin Endometrium – Endometrial lining does not grow beyond 6-7mm,leading to failure of implantation of pregnancy
  • Endometrial disease – Endometrial infection (endometritis), tuberculous infection, endometrial adhesions etc.
  • Allo-immune rejection of pregnancy – Failure of implantation due to rejection of pregnancy because of immunological incompatibility. In this case, the endometrial lining is normal and healthy and the embryo is also genetically normal.

Treatment of Recurrent Implantation Failures

  • Correction of endometrial disease
  • Measures to improve endometrial thickness – Estrogen supplements, drugs to improve blood flow to the endometrium (l-Arginine, Sildenafil)
  • Immunotherapy (LIT Therapy ) – In the absence of endometrial problem, immunological factor is an important cause of IVF failure and Immunotherapy (LIT Therapy) is beneficial in such cases.