Becoming parents is a cherished milestone for many couples, and advancements in medical technology offer hope to those facing challenges with natural conception.
In vitro fertilization (IVF) has emerged as a revolutionary solution, allowing couples to realize the dream of parenthood. Thanks to innovations like vitrification, IVF success rates have significantly improved, with cumulative pregnancy rates reaching as high as 60% among patients with favorable prognoses.
However, despite these advancements, approximately 10% of couples undergoing IVF encounter recurrent implantation failures (RIF), which can be emotionally and financially burdensome. Despite decades of research and advancements in reproductive medicine, RIF remains a significant hurdle. Understanding the complexities of this condition and the intricacies of the reproductive system itself continues to elude researchers.To shed light on why IVF failures recur and how success rates can be enhanced, we turned to Dr. Jasneet Kaur, Clinic Director and Senior Consultant in the Department of Reproductive Medicine at Milann Fertility Centre, Chandigarh.
Factors leading to repeated IVF failures
The reasons behind repeated IVF failures are often diverse, commonly linked to issues with the embryo, oocyte or sperm quality, and 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
Additional factors that have been associated with recurrent IVF failure include genetic abnormalities in parents’ karyotypes, thrombophilias, hormonal imbalances, and chronic infections.
Advanced diagnostic tests such as endometrial receptivity array, pre-implantation genetic testing of embryos followed by freeze-all strategy, and transitioning to blastocyst transfer may offer assistance in cases of recurrent implantation failure.
Genomic Modifications
In certain cases of recurrent implantation failure (RIF), there may be a displacement of the implantation window caused by intrinsic genomic alterations within the patient. This phenomenon is observed in approximately 25 percent of RIF patients. The assessment of this condition can be conducted through a test known as the endometrial receptivity assay (ERA). The ERA test provides information on the receptivity status of the endometrium, indicating whether it is receptive, post-receptive, or pre-receptive. Based on the results of the ERA test, the timing for embryo transfer can be adjusted accordingly for the patient.
Ways to increase the likelihood of becoming pregnant
- Utilizing preimplantation genetic testing for aneuploidy (PGT-A) is thought to enhance implantation rates in cases of Recurrent Implantation Failure (RIF).
- Traditionally, invasive trophectoderm biopsy was the preferred method. However, non-invasive screening, utilizing spent blastocyst media, is gaining prominence.
- Advanced sperm selection techniques such as IMSI, MACS, PICSI, and microfluidics can aid in refining sperm selection, thereby yielding higher-quality embryos.
- Moreover, employing deep learning through Artificial Intelligence can enhance embryo selection, consequently potentially boosting pregnancy rates.
Conclusion
IVF is a complex procedure with uncertain outcomes, which can be emotionally challenging for both parents and healthcare providers alike. Achieving positive results hinges on open communication with your doctor, discussing all aspects including risks and success rates. Given the unique nature of each case, a personalized approach to treatment is essential for optimal outcomes.