During this webinar session, Dr Halyna Strelko, Co-founder & Leading Reproduction Specialist at IVMED Fertility Center, Kiev, Ukraine, discussed egg donation failure and ways to overcome this.
Repeated implantation failure is the scenario in which embryos of presumably good quality do not yield positive results or give positive tests, leading to pregnancy arrest.
The phenomenon of low implantation rates is not unique to assisted reproduction; it is also observed in natural fertility. This concept is likened to an iceberg, where only around 30% of conceptions result in live births, highlighting the importance of understanding implantation. Quote 2 emphasizes this point:
Around 70% of all conceptions are lost prior to live births, akin to an iceberg, with only 30% leading to live births.
Several factors influence the probability of successful implantation, including the woman’s age, embryo quality, genetic testing, and the number of embryos transferred.
Repeated implantation failure is defined differently depending on the presence or absence of genetic testing. This distinction is crucial to determine when to consider it an issue.
In case of genetically tested embryos, even after one transfer, we can consider it repeated implantation failure.
Various maternal factors, such as lifestyle choices, anatomical issues, infections, immunological problems, and genetic anomalies, can contribute to implantation failure. These factors are summarized below:
Lifestyle choices like body mass index, stress, smoking, and alcohol consumption can significantly impact implantation success. Stress, for instance, can affect reproductive hormones, potentially leading to poor outcomes.
Vitamin D intake and thyroid function also play roles in implantation. While the scientific consensus varies, there is evidence suggesting their potential influence, especially in patients with low levels.
Obesity is associated with insulin resistance, hyperinsulinemia, and increased pro-inflammatory cytokines, which can adversely affect implantation. The degree of obesity may influence the outcome, with severe obesity potentially having a more significant impact.
Immunological issues, while less scientifically supported, can contribute to implantation failure. This includes anti-thyroid antibodies and other immune-related problems, which may require specialized treatment.
Anatomical defects such as myomas, polyps, and uterine abnormalities can impede implantation. Surgical interventions like hysteroscopy can address these issues, ideally followed by embryo transfer within three months.
Chronic endometriosis can affect up to 40% of infertile women, potentially leading to implantation failure. Infections and bacterial imbalances in the endometrium may also play a role.
Understanding the window of endometrial receptivity is critical. While testing this window before embryo transfer is debated, it may be beneficial in certain cases. The thickness of the endometrium is also pivotal, with an optimal range of 12–15 millimeters.
Embryo quality is crucial, with pre-implantation genetic testing offering valuable insights. Artificial intelligence can assist embryologists in selecting the best embryo for transfer.
Personalized approaches to treatment are essential, as there is no one-size-fits-all solution to implantation failure. A tailored approach based on the specific challenges of each patient is key.
In conclusion, understanding the factors contributing to egg donation failure and implementing personalized strategies can significantly improve the chances of successful implantation. While there is ongoing research and debate in this field, a thorough assessment of maternal, embryonic, and uterine factors is crucial in overcoming repeated implantation failure.
