September 13, 2012

Recurrent Implantation Failure: Why Me?

Implantation of the embryos depends upon on a well-developing embryo and a synchronous healthy endometrium. It seems deceptively simple. However, for such success to manifest, a highly-organized and amazingly intricate web of molecular interactions must first occur.

When pregnancy does not occur, our inclination is to look for both an answer and for a correction. Reproduction, by definition, is fraught with inefficiency, error and redundancies. A woman is born with approximately 2 million oocytes which dwindles to a mere 500,000 by her first period. Each month 300 oocytes become potential candidates to be selected to be the solitary oocyte to be ovulated. The male fairs no better. Eighty million sperm deposited filter to a few hundred into the fallopian tubes where only one sperm will fertilize the ovulated oocyte.

Clearly, we can hold accountable some of this inprecision to the unpredictability of Nature. However, with repeated failures of IVF cycles with otherwise healthy embryos, is it always the disfavorable coin flip? Unlikely not.

It may be termed repeated implantation failure (RIF) and it may be designated when otherwise favorable embryos fail to implant after several IVF treatment attempts. Obviously, patient characteristics (ovarian health and maternal age) influence outcomes. In general, 3 consecutive negative-outcomes in an IVF cycle should merit such a diagnosis and assessment. The assessment returns to the basic principles of reproduction: embryo and host crosstalk.

Maternal factors may be anatomic and or related to chromosomal impairments. An example of anatomic issues may be intrauterine polyps or fibroids. Congenital uterine anomalies should not be overlooked. Additionally the health of the fallopian tubes should be reassessed. Although the tube is superfluous when employing IVF, a diseased and swollen fallopian tube is proven to be deleterious. Chromosomal issues may be ruled out with a genetic analysis of both the man and woman. It may be performed through karyotype testing as well as newer genetic techniques such as SNP analysis.

Depending upon the diagnosis, treatment plans may include alternate approaches to IVF stimulation protocols, cryopreserved embryo cycles as well as preimplantation genetic screening using full complements of chromosomes (SNP or CGH analysis). We encourage patients to seek counsel from the reproductive endocrinology team – as we take this walk together.  Contact us today.

 

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Danielle Vitiello, Ph.D., M.D.

Danielle Vitiello, Ph.D., M.D. Board-Certified in Obstetrics and Gynecology, Reproductive Endocrinology and Infertility