Implantation Failure

 Implantation Failure

Implantation failure is the absence of gestation after 2 transfers of 2 good quality embryos, both fresh and vitrified. In these cases, when pregnancy is not achieved, special treatment is recommended to improve endometrial implantation as well as a better selection of the embryo to be transferred.

Causes

The causes of implantation failure are very diverse. Among the main ones are:

  • Age
  • Social habits
  • Hormonal habits
  • Immunology of the patient
  • Anatomical factors
  • Genetic factors
  • Presence of atrojenosis

In these cases, there are a number of techniques and treatments that can help achieve pregnancy:

Embryo selection:

The selection of the embryos that are best able to carry out the most important transfer in order to achieve the desired pregnancy. This situation can be solved in two new ways:

  • Time Lapse (embryoscope-Geri). The use of this technology allows a better selection of embryos according to the kinetic (evolution) parameters of the embryo during its entire culture in the incubator. Thanks to the “Time Lapse” the embryo follows its evolution in the culture medium itself without the need to read it outside the culture medium. With this we achieve a better embryo selection.
  • PGTA with NGS. This system allows us to analyse the 24 chromosomes of an embryo in less than 12 hours and transfer those that do not have any chromosomal abnormalities (recent studies have shown that patients with a good prognosis and aged 32 years have a 45% rate of genetic abnormalities in their embryos). With this technique we will increase the implantation rates in a 1st cycle to 75% and we will also decrease the incidence of miscarriages from 26% to 8-10%. In cases of problematic embryo transfers due to anatomically altered cervix or excessively stressed or nervous patients, we will practice a mild sedation for their better condition.

Thrombophilia studies

Sometimes it is necessary to perform a study to detect the presence of alterations in coagulation in patients with implantation failure.

To rule out the presence of endometriosis.

Vaginal ultrasounds

To achieve a good endometrial line, serial vaginal ultrasound scans should be performed with the aim of increasing the dose of oestrogens (oral and vaginal), vasodilators (sildenafil, pentoxifylline) and granulocyte colony-stimulating factors.

Improvement of the immune status

Study of the immunological situation of patients with the aim of achieving embryo implantation. In these cases we use:

  • Intralipid treatments, which reduce the immune response.
  • >Use of corticoids
  • Intravenous immunoglobulin treatment

Use of anticoagulants

Administration of subcutaneous heparin and sometimes associated acetylsalicylic acid.

Endometriosis

In case of endometriosis, pre-administration of LH analogues during treatment.

Hydrosalpinx

In case of hydrosalpinx, consider removal or tubal occlusion.

Endometrial stimulation

Enhance endometrial stimulation with pre-embryo transfer scratch and growth hormone administration.

TSH and T4 levels

Attention to TSH and T4 levels and vitamin D concentrations

Progesterone levels

Attention to progesterone levels during the endometrial preparation or embryo transfer phase.

Sperm abnormalities

In the event that your partner presents sperm abnormalities, we will carry out a selection of the spermatozoa prior to fertilisation using the MACS technique (annexin columns). With this technique we can eliminate the apoptotic spermatozoa (i.e. not suitable) for a good fertilisation.

Embryos in blastocyst stage

Also in our oocyte donation programme and implantation failures in general, we will transfer embryos in blastocyst stages to improve implantation for better selection and endometrial synchronisation.

Assisted hatching

In the case of frozen embryo transfers and in older women (over 40 years of age) we will perform assisted hatching.