Recurrent implantation failure: definition and management

Abstract

Recurrent implantation failure refers to failure to achieve a clinical pregnancy after transfer of at least four good-quality embryos in a minimum of three fresh or frozen cycles in a woman under the age of 40 years. The failure to implant may be a consequence of embryo or uterine factors. Thorough investigations should be carried out to ascertain whether there is any underlying cause of the condition. Ovarian function should be assessed by measurement of antral follicle count, FSH and anti-Mu¨llerian hormone. Increased sperm DNA fragmentation may be a contributory cause. Various uterine pathology including fibroids, endometrial polyps, congenital anomalies and intrauterine adhesions should be excluded by ultrasonography and hysteroscopy. Hydrosalpinges are a recognized cause of implantation failure and should be excluded by hysterosalpingogram; if necessary, laparoscopy should be performed to confirm or refute the diagnosis. Treatment offered should be evidence based, aimed at improving embryo quality or endometrial receptivity. Gamete donation or surrogacy may be necessary if there is no realistic chance of success with further IVF attempts.

Recurrent Implantation Failure and Low Molecular Weight Heparin

“…It involves, embryo apposition, adhesion, and invasion into the endometrium. First, the embryo attaches to the luminal surface of the endometrium, penetrates the epithelium followed by migration and invasion into the deeper layer of the endometrium to the circulatory system of the mother [2] [3].…”

“…Clinically, implantation is considered successful when evidence of intrauterine gestational sac is evident on ultrasound [3]. The implantation rate is defined as the number of intrauterine gestational sac seen by ultrasound divided by the total number of embryos transferred into the uterine cavity.…”

“…The implantation rate is defined as the number of intrauterine gestational sac seen by ultrasound divided by the total number of embryos transferred into the uterine cavity. In In Vitro Fertilization (IVF) cycles, the implantation rate is about 25% at day 3, increasing to 40 % on day 5 [3].…”

“…Defined "early" when a negative urine or blood pregnancy test is done 10 to 12 days after embryo transfer (no evidence of implantation with no detectable hCG) or "later" following successful migration of the embryo, hCG produced may be detected in the blood or urine but the process is disrupted before an intrauterine sac is visible on ultrasound (evidence of implantation with detectable HCG, biochemical pregnancy) [3]. IF is the result of failed implantation, placentation or compromise of early development [6].…”

“…This idea came after successfully treating antiphospholipid syndrome with aspirin and LMWH in case of recurrent pregnancy losses [3]. In order to improve cycle outcomes in women with RIF, heparin have been studied.…”