Failed IVF Cycle: What To Do Thenafter?
The process of Implantation involves 2 main components, a healthy embryo with a potential to implant and a receptive endometrium.
The success rate of IVF in the very first attempt after an embryo transfer is 55 per cent in women aged 35 or less. Women who do not conceive after first attempt of an embryo transfer should be investigated for reason for failed IVF cycle.
Implantation failure is related to either maternal or embryonic causes.
Maternal factor can be uterine, anatomic abnormalities, thrombophilia, non-receptive endometrium or certain immunological factors. Embryonic causes include either genetic abnormalities or factors which are intrinsic to the embryo that does not allow it to hatch or implant.
When we begin aligning the factor we should first rule out uterine anatomical factor which include a 3 D Ultrasound or a Hysteroscopic Examination.
We should rule out uterine septa, uterine fibroids specially the submucous types which are impinging into the uterine cavity, endometrial polyps, intrauterine adhesions and Hydro salpinx.
Uterine anomalies can be corrected during Hysteroscopy. However, Hydrosalpix needs laparoscopic tubal clipping before an embryo transfer.
Another maternal reason for a failed IVF can be thrombophilia, which can be either inherited or acquired. Thrombophilia is a Hypercoagulable condition in which there is disturbed blood flow to the endometrium and a tendency for clot formation. For such patients heparin is the solution which corrects the hypercoagulable state and improves the clinical pregnancy rates.
A functioning and receptive endometrium is also essential for a successful pregnancy. The window of implantation is a very crucial stage that lasts for very few days. The endometrium must proliferate during follicular phase with a good blood flow to the endometrium. The minimal adequate endometrium for successful implantation is 6.5 mm. The above mentioned window of implantation is characterised by morphological and histological changes of the endometrium. Patients who have a thin endometrium can be given a treatment option with intrauterine GCF infusion or intrauterine PRP installation.
When coming to the embryonic factor, an embryo is responsible for approximately one – third of a failed IVF cycle. Abnormal karyotype of the embryo is a major reason for implantation failure or miscarriage. Couples with an abnormal embryo should undergo karyotyping to rule out genetic abnormalities.
Embryos may be cultured to day 5 upto blastocyst stage for selection of healthy growing embryos. Some embryos with intrinsic factors do not grow upto blastocyst. It also enables more physiologic synchronisation with the endometrium and more capable of achieving window of implantation.
Cases with previous implantation failure must be thoroughly investigated to determine the most likely etiologies of the of the condition, as this is a complex problem with several variables. IVF protocols and transfer cycles should be specially tailored according to the patient.
