Implantation Failure in Assisted Reproduction Technology and a Critical Approach to Treatment

Abstract

In this article, we review the literature and our personal experience regarding the many factors that appear to influence implantation rate. Oocyte quality, as determined by patient age and aneuploidies, probably plays a major role in RIF. However, a panoply of other factors have been brought under investigation, quite often with contradictory results and additional intriguing questions to be studied. Infections of the vagina, cervix, and endometrium, the role of mucus aspiration and washing of the cervix on transfer, the role of catheter guidance for a correct transfer and potion of embryos, the effect of mock transfer, and the role of hysteroscopy and its timing before transfer procedures are analyzed both as a review of the literature and as opinions and data from our experience. Many of these factors are interlaced and from the apparently simple issue of trauma, to infections and immune modulation of hatching and implantation, a biological continuum can easily be identified. The impact of abnormalities of the immune system and of homeostasis abnormalities is also covered in a brief overview of reported works and our experience. These latter areas probably constitute the common biological background of all other external factors that, however, the skilled must equip themselves for improving implantation success.

Hysteroscopy in recurrent in-vitro fertilisation failure (TROPHY): a multicentre, randomised controlled trial

“…7,8 Hysteroscopy allows visual assessment of the cervical canal and uterine cavity and provides the opportunity to perform corrective surgery in the same setting. [8][9][10][11] Routine outpatient hysteroscopy before starting in vitro fertilisation treatment has been proposed as a tool to confirm or restore normality of the uterine cavity and improve in vitro fertilisation treatment outcome. [12][13][14] A systematic review of published studies has suggested that outpatient hysteroscopy performed in the menstrual cycle preceding an in vitro fertilisation treatment cycle could significantly increase the clinical pregnancy rate in women who had previously experienced recurrent implantation failure, even when no hysteroscopic abnormality was detected.…”

Proteomic Analysis of the Luteal Endometrial Secretome

“…Embryo implantation is necessary for survival of the human embryo and abnormalities in the implantation process are thought to cause infertility, pregnancy loss, and reduced success of in vitro fertilization (IVF) therapy 1,2. The endometrium becomes receptive to embryo implantation only during the mid-secretory phase, outside of which successful implantation does not occur.…”

A multi-centre randomised controlled study of pre-IVF outpatient hysteroscopy in women with recurrent IVF implantation failure: Trial of Outpatient Hysteroscopy - [TROPHY] in IVF

“…OH is a well-tolerated minimally-invasive procedure, which allows reliable visual assessment of the cervical canal and uterine cavity and provides the opportunity to perform therapy in the same setting [5,8-11]. Intra-uterine pathologies have been shown to be present in 25% of infertile patients [11].…”

“…OH is a well-tolerated minimally-invasive procedure, which allows reliable visual assessment of the cervical canal and uterine cavity and provides the opportunity to perform therapy in the same setting [5,8-11]. Intra-uterine pathologies have been shown to be present in 25% of infertile patients [11]. Thus, routine OH prior to IVF has been suggested by a number of investigators to ensure normality of the uterine cavity before embryo transfer [12-19] although this proposition has not been tested in a randomised setting.…”