Patients who have undergone in vitro fertilization (IVF) three or more times and have had high-quality embryos implanted but still experience continuous failure or only achieve chemical pregnancies are classified as having recurrent implantation failure. This type of recurrent implantation failure exhibits mechanisms similar to the early forms of habitual miscarriage, so it is essential to conduct various tests to identify the underlying causes.
Causes and Tests
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Structural abnormalities of the uterus
Hysterosalpingography, ultrasound of the uterus, hysteroscopy
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Anatomical factors of the uterus
Hysterosalpingography, ultrasound of the uterus, hysteroscopy
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Genetic factors
Chromosomal abnormalities testing using the couple's blood
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Bacterial infections
Testing for bacterial infections such as vaginitis or salpingitis
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Hormonal and metabolic abnormalities
Tests for ovarian function, obesity, diabetes, thyroid hormones, or prolactin levels
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Immunological factors
NTesting for Natural Killer (NK) cells and various autoantibodies
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Thrombophilia factors
Genetic mutation tests for related genes such as C protein, S protein, antithrombin III, MTHFR gene C677T polymorphism, Factor V Leiden, Prothrombin, and homocysteine to assess placental blood circulation disorders
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Endometrial factors
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Male infertility factors
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Medical history
Review of lifestyle habits, work environment, and medication use
Reduced endometrial receptivity
| Causes |
Treatment |
|---|
- anatomical factors of the uterus
|
Check for abnormalities with hysteroscopy |
- thin endometrium
|
endometrial stimulation and biopsy, various drug treatments
(such as Viagra, high-dose estrogen) |
- immunological factors
|
administration of immunoglobulins, steroids, heparin, and aspirin |
- thrombosis
|
blood tests to assess placental blood circulation disorders |
Reduced embryo quality
| Causes |
Treatment |
|---|
genetic abnormalities:
Preimplantation genetic screening |
To check for chromosomal abnormalities |
| zona pellucida hardening of the egg |
Perform assisted hatching or blastocyst embryo transfer |
Others
| Causes |
Treatment |
|---|
| Zona pellucida hardening of the egg |
use of gonadotropin - releasing hormone analogs |
| hydrosalpinx |
laparoscopic surgery to perform salpingectomy |
Implantation Failure and Endometrium
When there is permanent damage to the basal layer of the endometrium due to uterine surgery or endometritis, reduced blood circulation in the basal layer of the endometrium following uterine fibroids or surgery, endometrium that does not respond to estrogen treatment, inadequate response to ovarian stimulation injections, or excessive secretion of male hormones from the ovaries, the likelihood of successful implantation in the endometrium decreases.
As the causes of recurrent implantation failure are diverse and complex, it is essential to find the underlying cause through thorough consultation, observation, and testing with an experienced fertility specialist, and to provide appropriate treatment to improve the chances of successful implantation.