There are many interventions that can increase your chances of conceiving and delivering a
baby. You are encouraged to see the doctor for consultation to discuss your options.
Recurrent implantation failure
Recurrent implantation failure is usually defined as more than 3 transfers of embryos without
implantation (no positive pregnancy test). It is difficult to understand why implantation does not
occur but age, embryo quality and submucosal fibroids are known to affect implantation.
Age of the woman
As a woman gets older, the chance of conception from IVF treatment
declines. This is a well established fact and is most likely secondary to the increasing number of
abnormal (aneuploidic) embryos created as a woman gets older. Unfortunately there is no
treatment for this.
There is a reduced chance of conception if the embryo quality is poor.
Although embryo quality is a purely subjective analysis made on the appearance of the embryos,
there is good evidence to suggest that poorer quality embryos are less likely to implant with
overall pregnancy rates being less.
Fibroids located within the uterine cavity are known to· cause
implantation failure and should be removed prior to commencing treatment. They are diagnosed
by ultrasound scan with saline instillation sonography and treated by means of a hysteroscopy
and transcervical resection under general anaesthetic.
What we don’t know or is not established currently in the literature: Immunological Causes and Blood Flow. Aberrant immune responses may be related to infertility, implantation failure and recurrent pregnancy loss. The regulation of uterine and circulating peripheral blood natural killer (NK) cells has been associated with reproductive failure with NK cells reacting abnormally to an implanting embryo, treating it as an invading cell and signalling for the body to attack it. The prognostic value of measuring peripheral or uterine NK cells however remains uncertain. The value/role of NK cell assessment as a predictive test for screening women who may benefit from immunotherapy has not been proven with most studies being insufficiently large enough to make a proper assessment.
Intralipid has been shown to suppress Natural Killer Cell toxicity as evidenced by
both animal and human studies. Studies have found that intralipids can help to regulate NK cells,
allowing the embryo to implant on the uterine wall and grow normally. Research has suggested
that women who have experienced recurrent implantation failure or multiple failed IUI or IVF
cycles as a result of NK cell activation may benefit from the use of intralipids. Intralipid is the
name of a fat emulsion used to provide essential fatty acids for intravenous nutrition. Intralipid
also contains soya oil, glycerol, purified egg phospholipids and phosphate. Intralipds are given
via a drip and have few side effects with excellent patient tolerance. Immunoglobulin (IVIg) has
also been shown to supress Natural Killer Cell toxicity. The benefit from the use of intravenous
immunoglobulin has yet to be proven.
Thyroid Peroxidase Antibodies
Have been associated with an increased prevalence of
recurrent implantation failure. Studies are being performed to investigate the efficacy of giving
Thyroxine to women to assist implantation.
A diagnosis of antiphospholipid syndrome should only be made if the antibodies (anticardiolipin antibodies and/or lupus anticoagulant) are persistently positive in tests done at least 12 weeks apart. Although many studies have shown an increased prevalence of antiphospholipid antibodies among women undertaking IVF, prospective studies have shown that mere presence of these antibodies does not affect either the implantation or ongoing pregnancy rate.
Subcutaneous Heparin; although there is little evidence to support the use of
Heparin with no substantial evidence of improvement in pregnancy rates.
Activated protein C resistance, deficiency in protein C/S, deficiency
in anti-thrombin III, Hyperhomocysteinemia and prothrombin gene mutations have been
associated with recurrent implantation failure.
Heparin. Heparin has been shown to be of benefit in improving implantation rates in
women with thrombophilia.