With a growing infertility problem in the country, more people are adopting IVF treatment as a form of assistive reproductive procedure.
First introduced in 1978, IVF has come a long way in the last four decades with improved drugs, better lab equipment and advanced medical technologies. While the average success rate of IVF is within the range of 30% and 35%, in some cases the procedure has reached a success rate exceeding 50%.
Still, like with any other technology, IVF cannot always promise a guarantee of successful pregnancy due to several factors. While many people get successful with the first IVF cycle, some have to try twice or even three IVF cycles. But failure more than three times is labelled as recurrent implantation failure. Not only emotionally and physically, but repeated IVF failure can also be financially draining.
There can be many factors that can cause the failure of embryo implantation. However, the most common factors are found to be embryonic, oocyte or sperm or uterine related. Another reason why repeated IVF failure is getting common is advanced maternal age as couples are choosing to get married late or planning pregnancy late. Poor quality of eggs or sperm due to smoking, stress, obesity and poor lifestyle are also contributing factors.
One of the main reasons behind implantation failure is hostile uterine. Any sort of uterine malformations such as intrauterine adhesions, endometrial polyps or submucous fibroid can be the cause of repeated IVF failure.
A detailed pelvic scan is an easy way to find out about such malformations and different medical therapies are possible to increase the chances of implantation depending on the cause. If the uterine scan shows a large intramural fibroid, it needs to be removed surgically to enable embryo implantation.
If the repeated IVF failure is a result of septum of adhesions in the uterus, it can be corrected with hysteroscopy. Also, if there is a hydrosalpinx present, then the laparoscopic disconnection of fallopian tubes will help.
As it is evident that uterine assessment and the following treatment is important for improving IVF success rate, you must choose the best IVF doctor in Pune.
Improving Embryo Selection
The modern technology improvements have made it possible to culture embryos till day 5 or day 6, unlike earlier when they were cultured on day 2 or day 3.
What does this mean?
After successful fusion of the egg with the sperm the embryo is formed, but previously it had to be implanted on the second or third day of infusion leaving very little scope to evaluate the embryo at its blastocyst stage. As the implantation of the blastocyst embryo is much higher than the cleavage stage, we have a chance to improve the selection process. With preimplantation genetic screening (PGS) of embryos, it can be decided whether the embryo is genetically normal or not.
Patients who have a high repeated IVF failure rate are more prone to produce chromosomally abnormal embryos. Such embryos do not implant despite looking good morphologically. Pick an best IVF center in India that offers the capability to check the chromosomal makeup of embryos. If the embryo is euploid, i.e., its chromosomal makeup is normal, it will have a higher implantation rate implying a very high IVF success.
In some patients, auto immune diseases like abnormal coagulation and SLE can cause embryo implantation failure. For such people, comprehensive blood work to medically treat the condition is recommended before embryo transfer. Low molecular weight heparin is used to treat patients here. If the patient has an immune disorder, then immunomodulatory drugs are recommended.
Endometrial Receptivity Assessment
The state of the endometrium (the lining of the uterus) is an important factor to consider before an embryo can be implanted to prevent failure. A normal transvaginal scan assesses the thickness and pattern of the endometrium. If the scan shows that the endometrium is 8mm or above it is considered good for implantation.
But in repeated IVF failure patients it is important to assess endometrial receptivity through a test called Endometrial Receptivity Assay (ERA). The result of the test can tell whether the endometrium is receptive, post-receptive or pre-receptive. Then accordingly a plan can be made to transfer the embryo to the patient at right stage, this is known as Personal Embryo Transfer.
Some evidence support endometrial scratching to increase implantation rate but the trial data still is not enough to be entirely reliable. A more controversial treatment is the use of autologous platelet-rich plasma (PRP).
Also, the endometrium is more receptive in the frozen embryo cycle as compared to the stimulated cycle.
Facing unsuccessful IVF cycles is not only emotionally taxing but also frustrating. If you are failing to achieve pregnancy following several cycles of IVF, it is time you consider a more personalised approach. Consult the best IVF doctor in Pune for the best course of action for a successful pregnancy.
By Kevin Bing