Being a parent can be one of the most joyful moments in the life of a couple. With improvements in technology, the couples who can't conceive naturally can now experience the bliss of parenthood with advanced fertility treatments like In vitro fertilization or IVF. Fortunately with cutting edge technologies available today, especially vitrification, there has been a marked improvement in the success rates of IVF worldwide. The cumulative pregnancy rates in good prognosis patients is as high as 60%.
However, despite all the progress, approximately 10% of couples undergoing IVF faced recurrent implantation failures (RIF) that can be emotionally and monetarily overwhelming for them. RIF remains a major challenge even after four decades of IVF. Despite extensive research a comprehensive understanding of the condition and intricacies of the reproductive system itself, remain elusive. We reached out to Dr. Jasneet Kaur, Clinic Director and Sr. Consultant (Dept. Of Reproductive Medicine) at Milann Fertility Centre, Chandigarh to know why IVF failures recur and how the procedure can be made successful.
Causes of Recurrent IVF Failure
The causes of recurrent IVF failure could be multiple and varied though usually attributed to embryonic factors, oocyte or sperm or uterine factors.
Advanced maternal age
Late marriages are becoming common these days as people wish to achieve their other life goals before settling down. Marrying late often results in delayed pregnancy planning. Advanced maternal age is, therefore, a prominent factor in IVF failures. If the mother is 35+ years, she is at risk of IVF failure. The risk increases with age.(click here to know late pregnancy risks)
Genetic Issues
Other conditions that have been implicated are genetic causes (parental karyotype abnormalities), thrombophilias, hormonal disorders, and chronic infections
Advanced tests like endometrial receptivity array, genetic analysis of embryos before transfer with a freeze-all approach, and moving towards blastocyst transfer might be of some help in patients with RIF.
Also Read: 5 Questions To Avoid Asking A Couple Undergoing IVF
Genomic Modifications
In some patients of RIF, the implantation window is displaced due to some intrinsic genomic alteration inherent in the patient, an observation found in about 25 percent of patients with RIF patients. This can be assessed by a test called endometrial receptivity assay (ERA), which can tell us whether endometrium is receptive, post-receptive, or pre-receptive, and accordingly we have to plan embryo transfer for the patient.
How to improve chances of conception?
- Performing preimplantation genetic testing for aneuploidy(PGT-A) is believed to improve the implantation rates in RIF.
- Traditionally, invasive trophectoderm biopsy was preferred. But now non-invasive screening, using spent blastocsyt media is coming up in a big way.
- Advanced sperm selection techniques like IMSI, MACS, PICSI, and microfluidics can help in improved sperm selection, resulting in better quality embryos.
- Also deep learning using Artificial intelligence can help in better selection of embryos, which in turn can lead to an improvement in pregnancy rates.
Conclusion
IVF is a critical procedure with no guaranteed results. It can get frustrating for both parents as well as care providers. To get positive results, it is important that you speak to your doctor and talk about all the aspects including risks and success rates. Every case is different and so is their result. You should have a personalised approach towards the treatment to get promising results.
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