Implantation failure is defined as the failure to achieve a pregnancy after three cycles of in vitro fertilization, IVF, or after the transfer of more than 6 to 10 good quality embryos.
For professionals like us, this definition is incomplete, since it should take into account the number of attempts made. The age of the patient, the number of embryos in each attempt, the embryonic quality and also the presence of factors that affect implantation.
In order to adequately address this problem, it is essential to know the cause through experts in gynecology, sterility and infertility.
The specialists of Institute of Gynecology of Barcelona Dra. Gómez Roig offer you, within your medical services, specialized care to address IVF implantation failure.
Who should undergo in vitro fertilization?
In vitro fertilization or IVF is offered to couples with the following needs:
- Women with pathology in the fallopian tubes, due to previous surgery, scars, etc.
- Presence of a severe male factor: very low sperm count or very low motility. Sometimes it is necessary to surgically remove the sperm from the testicles.
- Advanced reproductive age, since the higher the female age the pregnancy rates are lower.
- All other causes of sterility. In this group we include endometriosis, ovulation disorders and sterility of unknown cause. Also if there have been other previous ineffective treatments.
- Hereditary genetic diseases that you do not want to pass on to your children. In these cases, the IVF is combined with pre-implantation genetic diagnosis called: preimplantation diagnosis.
- Ovarian failure due to the inability to produce follicles and oocytes. These cases will need donor eggs.
The couples to whom the techniques of Assisted reproduction such as IVF are recommended, must be well informed of the risks, benefits and treatment alternatives on the IVF implantation failure.
How can I know if I will have a successful pregnancy with IVF?
To find out if your IVF cycle will be successful, a calculator to know the probability of success of the treatment during the first three cycles has been developed.
You can also know how it will go in case of using donor gametes. At the same time it can be calculated based on the number of embryos transferred.
This calculator is available free of charge on the website of the Assisted Reproductive Technology Society (SART) in the section: see web.
Women who are considering starting a cycle can enter their details on the website to find out the expected results.
What factors are associated with greater or less treatment success?
The factors that are associated with success rates are several.
Next, we explain them based on:
- Factors associated with the success of IVF.
- Factors with a negative effect.
- No effect or modest influence.
Factors associated with IVF success
Several factors prior to the procedure can affect the IVF success. Age of the woman, cause of infertility, personal history and also previous pregnancies.
Maternal age
The main determinant of success is the age of the woman.
Although IVF can exceed the fertility level of younger women, this technique does not compensate for the decline due to age. Particularly in women over 40 years of age.
Studies show that with treatment the percentage of births by maternal age is as follows. Under 35 years old: 40.7%, 35 to 37: 31.3%. De 38 a 40: 22.2%, 41 to 42: 11.8%. Y more than 42 years: 3.9%.
In addition, the risk of miscarriage is significantly higher in older women.
Adequate ovarian reserve
The ovarian reserve is the response capacity of the ovaries when the woman is treated to achieve successful ovulation.
The hormonal factors influence this answer:
- The blood concentration of serum follicle-stimulating hormone: FSH, and estradiol may help predict IVF success. A high FSH level is a poor prognostic factor. Despite this, this test has its limitations.
- Elevated estradiol concentrations are also associated with poorer pregnancy outcome. As with FSH measurements, estradiol levels vary widely and must be interpreted with caution.
We usually measure the serum FSH and estradiol in all women older than 35 years who are contemplating IVF.
There are other tests to measure ovarian reserve, such as ultrasound assessment of antral follicle count or ovarian volume, or measurement of inhibin B levels or antimüllerian hormone: HAM. None of these tests has been superior to the others.
- HAM is a good indicator of poor or excessive ovarian response, but it does not influence the number of final live births.
- An gynecological ultrasound and the antral follicle count can be informative. A low count is a good predictor of poor response to medication.
In existing studies, it appears that the value of HAM is somewhat superior to that of ultrasound. The hormone correlates better with a good ovarian response after its stimulation.
Factors with a negative effect
Let's see the factors with a negative effect.
Hydrosalpinx
It is well known that the presence of a hydrosalpinx, a fluid accumulated in the tube, is associated with a poor result in IVF.
In these cases, the rate of live births is half that of women without this pathology.
Removing the tube containing the fluid before treatment in women improves pregnancy rates and should therefore be recommended.
Stagnant fluid can prevent pregnancy by impairing the quality of the transferred embryo or the implantation of the pregnancy in the uterine wall.
Smoke
Cigarette smoking reduces success rates for IVF and is associated with numerous adverse effects on general health. We recommend smokers to quit smoking.
Factors with no or modest influence
Another case is factors with no effect or with a modest influence, which we will break down below.
Fibroids or uterine fibroids
Fibroids are muscular benign tumors that originate in the wall of the uterus called the myometrium.
The effect of fibroids in the results of assisted reproduction depends on its location. The myomas can be external: subserosal; in the wall of the uterus: intramural; or in contact with the internal wall or endometrium: submucosal.
The submucous fibroids decrease the chance of success, while subserous fibroids do not seem to have any effect.
The effect of intramural fibroids is not clear.
Endometriomas and endometriosis
The role of endometriomas and endometriosis on the success of IVF is unclear.
Generally, if an endometrioma is small and has no symptoms, it is not routinely removed before treatment.
There is no consensus on the optimal approach.
Resecting the cysts, that is, surgery, does not improve the results of the treatment and, on the contrary, can damage the ovarian reserve: ovarian response capacity to respond to medications.
History of a previous pregnancy
Having had a previous pregnancy is associated with a higher probability of success of the assisted reproductive technique.
On the other hand, a history of one or more abortions does not significantly reduce the probability of success.
Unsuccessful previous IVF cycle
Having made a previous IVF cycle, and not having been successful, does not appreciably decrease success rates during subsequent treatment.
It is from the fourth attempt that the probability decreases.
Obesity
Infertility is more common among overweight and obese women. At the same time, obese women have less successful cycles.
In a study of nearly 500.000 new IVF cycles, obese women reduced pregnancy rates by 6% and live birth rates by 13%.
According to existing studies, overweight women also have more cases of miscarriage, low birth weight newborns, and preterm births.
Aspirin, acupuncture, heparin
The use of aspirin, acupuncture, or heparin has not been shown to significantly improve pregnancy rates during any IVF cycle.
Thrombophilias
thrombophilias are a disease related to blood clotting. Alteration of coagulation factors favors thrombosis, although not always significantly.
These diseases do not appear to have an adverse impact on treatment success rates.
The available evidence suggests that heparin treatment is not routinely indicated when these women undergo IVF.
Endometrial thickness
The endometrial thickness measured by gynecological ultrasound has turned out to be a poor indicator of the occurrence of pregnancies after assisted reproductive techniques.
What if IVF doesn't work?
In vitro fertilization has a good success rate in most cases. In general, approximately 27% of cycles will end with a live newborn, and the chances of success are greater with more than one cycle performed.
However, the probability of success of a person depends on several factors: the age of the woman, the cause of the infertility and the treatment approach.
In assisted reproduction techniques, it is often difficult to face emotional changes.
Psychological support is important in this type of problem.
The Institute of Gynecology of Barcelona Dra. Gómez Roig works daily to offer the best medical and psychological care to couples with sterility and/or infertility problems.
If you have any questions about IVF Implantation Failure You can contact us or make an appointment.
Related Entries
Sterility Causes and Treatments
Repetition Abortions
Psychological Support for the Couple
- About the Author
- Last tickets
Head of the Obstetrics and Gynecology Service at the Sant Joan de Déu Hospital in Barcelona. Associate Professor of Obstetrics and Gynecology and Coordinator of the Sixth Course of Medicine at the University of Barcelona, UB. Director of the Dra. Gómez Roig Institute and Coordinator of Obstetric and Gynecological Processes at the Corachan Clinic in Barcelona.