RECURRENT IMPLANTATION FAILURE
Now-a days , IVF and ICSI are successful treatment options available for infertile couples . However , inspite of a number of transfers with apparently good embryos some cycles don’t end in a successful implantation . Successful embryo implantation requires both a synchronous development and interaction between the embryo and the endometrium.
Recurrent implantation failure refers to failure to achieve a clinical pregnancy after transfer of at least four good-quality embryos in a minimum of three fresh or frozen cycles in a woman under the age of 40 years. RIF imposes a significant physical , emotional and financial burden on the infertile couples and is a problem for every IVF clinic as the responsibility falls on the treating physician to explain the possible reasons.
RIF may be a consequence of embryonic or uterine factors or both.
Broadly it may be divided into
Hysteroscopy or endometrial scratch/ injury ---There is enough evidence to support that these procedures if done in the cycle before ovarian stimulation and IVF/ET increase the pregnancy rate in RIF patients .
Endometrial Receptivity Array – The newly acquired capacity of the endometrium to welcome the embryo is termed “endometrial receptivity” and the short period of time in the menstrual cycle, when the endometrial receptivity is optimal and embryo implantation is possible, is called “window of implantation” (WOI). The result is the development and growth of a viable conceptus . ERA is a reliable and reproducible test for determination of the exact time of the WOI for an individual and can make it possible to apply a personalized embryo transfer in patients with RIF thus improving the chances of successful implantation.
DNA Fragmentation Index – Assessing the degree of damage to sperm DNA by these special tests would help identify those couples that would benefit from ICSI treatment.
The treatment offered should be aimed to improve the embryo quality and the endometrial receptivity. Several treatment strategies have been described to improve the endometrium receptivity and these include immunomodulatory agents, local endometrial injury, autologous derived stem cells, etc. For immunological factors immunomodulation IVIG (intravenous immunoglobulin IgG) are widely used. Immunotherapy with IVIG or intralipids when applied in patients with abnormal immunological risk factors might increase the live birth rates .
The couple should be offered gamete donation or surrogacy if there is no realistic chance of success with further IVF attempts.