Implantation Failure in IVF - Is the Uterus or the Embryo?

Using a systematic protocol will help in determining the cause of repeated failed implantation during In vitro fertilization treatment.

In vitro fertilization does not have a 100% success rate. Good IVF doctors educate patients about the chances of failure before they go in for IVF. When the IVF cycle fails, patients who have not been properly counseled may lose trust in the doctor's abilities , if they are not well- informed.

Disheartened patients then consult another doctor in a desperate attempt to conceive. In order to prove that he is better than the old doctor, the new IVF specialist may then order a battery of expensive tests, to try to "pinpoint" what the reason for the failure is. Often this is a game of "medical one-upmanship" because most tests rarely provide any useful information.

If the next cycle also fails, patients lose faith in IVF doctors and will often choose to abandon in vitro fertilization as a treatment option . Others will doggedly continue their search for the right doctor. The trauma of repeated failures , combined with the lack of a clear explanation about the cause of the failures leads to continued stress in patients. Repeated switching of doctors adds to the stress !

The fundamental reason behind switching doctors is to find a doctor who can guarantee them success with the In Vitro Fertilization procedure. Unfortunately, there are few guarantees in life . The mindless repetition of identical treatment protocols without doing a thorough analysis becomes taxing for the patient - both emotionally , as well as financially. To add insult to injury, many doctors end up blaming the patient for the IVF failure , by stating that it is because they are too stressed that their uterus is rejecting their embryos ! The poor emotionally vulnerable patient gets even more depressed on hearing this.

If embryos fail to implant after transfer, the problem could lie either with the uterus or with the embryo ( assuming the embryo transfer procedure goes smoothly ). If the embryos are of poor quality, then the likelihood is very high that it is the embryos which are responsible for the failure. The commonest reason for poor quality embryos is poor quality eggs . Other reasons include a bad IVF laboratory ; and a sub-optimal superovulation IVF protocol.

Sometimes, the problem is with the uterine lining, and this can be diagnosed during the ultrasound scans, which show that the endometrium remains thin and does not become trilaminar. This damage maybe because of an earlier D&C, which has created adhesions; or uterine infections , such as TB.

If the patient's embryos develop into Grade A blastocysts in the lab; and she fails to conceive after the transfer of 6 Grade A blastocysts over 3 cycles, then it is reasonable to consider alternative options such as surrogacy .

Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.