What could be more frustrating than to have a beautiful embryo transferred into your uterus and then not be pregnant?
But you saw the picture of the embryo- it was perfect! The embryologist even said so. And the doctor told you it was a high grade blastocyst. Your uterus was beautiful with a perfect 8 mm triple pattern line- so how come the embryo did not stick?
This is called implantation failure and when it happens more than once with good quality embryos, we call it recurrent implantation failure. It is one of the toughest diagnoses to deal with, as it is hard for doctors to know what causes it and what to do to fix it.
There are many different definitions of recurrent implantation failure in the literature. Without defining a disease, it is hard to study and treat it.
The doctors at Reproduction Science Center have come to a consensus on a definition for our patients:
- If a patient is less than 38 years old and fails to implant in 2 IVF cycles (fresh or frozen) with at least 2 blastocyst embryos transferred (grade 3BB or better), we consider this recurrent implantation failure.
- If a patient is > 38 years and < 42 years old and fails to conceive with 4 blastocyst embryos transferred (grade 3BB or better), then we consider this recurrent implantation failure.
- If a patient is >42 years old and fails to conceive with 2 transfers of at least 2 euploid embryos (after PGS screening), then we consider this recurrent implantation failure.
- The patient must also have a normal uterine cavity on saline sonogram, HSG, or hysteroscopy and have a lining thickness of 8 mm with a triple pattern, otherwise the implantation problem may truly be an abnormal uterus that could be fixed.
- The patient does not have a hydrosalpinx (fluid-filled fallopian tube) as proven by HSG X-ray.
The doctors at RSC have also come up with a series of recommendations for testing and treatment for patients diagnosed with RIF (recurrent implantation failure).
Additional treatment and testing includes:
- Consider PreImplantation Genetic screening of the embryos if a fresh cycle is needed
- Intrauterine HCG with a frozen transfer
- Hysteroscopy with endometrial scratching or Endometrial Scratching alone
- Intramuscular progesterone ( instead of vaginal progesterone in a frozen transfer cycle
- Endometrial Receptivity Testing through the ERA test by IVIGEN
- Karyotypes on both parents
- Consider the empiric use of an injectable blood thinner like Lovenox
Other things to consider include lifestyle optimization through stress reduction, dietary changes, and acupuncture. At RSC, we address these types of issues from the very first cycle, but ideal body weight or greater attention to lifestyle issues may take a continued effort.
Through continued diligence and careful attention to all the factors that influence IVF success, we have been able to overcome recurrent implantation failure in many cases. So remember the old adage: “people who make blastocysts can make babies” and stay strong in the process.