When IVF Fails: Exploring Reasons for Implantation Failure - Part 2
Repeated IVF Failure – Important Considerations
HYDROSALPINGES
Prior to IVF treatment, most programs perform an evaluation of the fallopian tubes to rule out fluid filled tubes (hydrosalpinges) because multiple studies have confirmed that IVF success rates will be reduced by almost one half if a hydrosalpinx is present. If a careful evaluation of the fallopian tubes has not been done within the preceding one year, this should be done.
EGG QUALITY
Poor egg quality may be the most common cause repeated IVF failure. Poor egg quality is suggested by elevation of cycle day 3 FSH or estrogen levels, low levels of antimullerian hormone levels (AMH), low egg counts on ultrasound evaluation of the ovaries, poor response to controlled ovarian stimulation. Poor egg quality is also suggested by reduced fertilization rates, or the presence of a large number of immature eggs at the time of egg retrieval. If poor egg quality is the explanation for repeated IVF failure, the options are limited. Some preliminary research has suggested that supplementation with DHEA (dehydroepianrosterone) and Coenzyme Q10 may improve egg quality if used for approximately 3 months prior to egg retrieval, although this approach is somewhat controversial at this time.
SMOKING
Smoking is associated with increased medication requirements for ovarian stimulation, fewer eggs retrieved, more cancelled cycles, lower implantation rates, and more cycles with failed fertilization.
ABNORMAL EMBRYONIC DEVELOPMENT
Chromosomal abnormalities in the male or female partner may lead to an abnormal embryo.
Increased incidence of sperm chromosomal abnormalities may be found in some men in spite of a normal appearing semen analysis.
Increased thickness or hardening of the membrane that surrounds the embryo may interfere with implantation.
There is some evidence that culturing conditions in the laboratory may sometimes be sub-optimal resulting in poor quality embryos. Laboratories require careful quality control and periodic equipment upgrades to achieve optimal results.
Embryos may have loss or gain of an entire chromosome (aneuploidy). Aneuploid embryos will either fail to implant, result in pregnancy loss, or an affected infant.
EMBRYO TRANSFER TECHNIQUE
Embryo transfer technique is critical to IVF success. It is important that the transfer be done gently, with a full bladder, and under ultrasound guidance. The use of specially designed soft catheters is also associated with significantly better outcomes. Care should be taken to avoid blood and mucous on the embryo transfer catheter.
