Juniper Publishers: Recurrent Implantation Failure What is beyond Endometrium and Embryo
JUNIPER PUBLISHERS- JOURNAL OF GYNECOLOGY AND WOMEN’S
HEALTH
Journal of Gynecology and Women’s Health-Juniper
Publishers
Authored by Mohamed Elmahdy*
Opinion
Recurrent implantation failure (RIF) is defined as
failure to achieve pregnancy after transfer of embryos of good quality
to implant in women under age of 40 following several in vitro
fertilization (IVF) treatment cycles [1].
The failure to implant is due to declined endometrial receptivity,
defective embryonic development and other factors like endometriosis,
presence of hydrosalpinges [2].
Factors which might cause defective endometrial receptivity include
uterine polyps, septa, leiomyomata and adhesions, thin endometrium and
lack of good culture media for intra cytoplasmic sperm injection (ICSI) [3-5].
35% of patients with RIF were found to have chronic
endometritis (CE), confirming the importance of sampling the endometrial
cavity in recurrent IVF-ET failures. This pathology may permanently
alter the integrity or biochemical milieu within the endometrial cavity [6]. Office hysteroscopy is a useful diagnostic tool but should be complemented by an endometrial biopsy for the diagnosis of CE [7].
Recurrent ectopic pregnancy is one of the risk
factors of RIF. The declined intrauterine implantation rate to some
extent indicates an altered endometrium, which may play an important
role in the pathogenesis of ectopic pregnancy [8].
Altered endometrial receptivity may be associated
with immunological problems. Women with RM and RIF showed an increase of
circulating proinflammatory cytokines, altered endometrial T
lymphocytes subsets, and signs of endometrial ER stress [9].
Repeated implantation failure after IVF relates to diminished plasma volume along with increased uterine vascular resistance [10].
leukaemia inhibitory factor mRNA expression was significantly decreased
in abnormal uterine cavities during the midsecretory phase, indicating
that endometrial cavity defects are a possible cause of poor
reproductive outcomes [11].
Inherited and acquired thrombophilias are encountered
in many cases of RIF. Factor V HR2 was found to be associated with RIF
and screening for the HR2 haplotype should be done in these patients [12].
Factor XII may be a good predictor, while there is no role to measure
protein C, protein S, antithrombin III, or factor XIII. [13].
As regards acquired thrombophilia 9% of women with a history of
recurrent implantation failure had more than one positive
antiphospholipidantibodies [14].
Advanced maternal age is associated with a high
frequency of chromosomal abnormalities. However, an even greater
frequency of chromosomal abnormalities was seen in poor prognosis women
with RIF regardless of age [15].
In women with recurrent implantation failure, two consecutive euploid
IVF/PGD cycles is associated with a high ongoing pregnancy and
implantation rate [16].
Recurrent implantation failure is a night mare for
both the patients and the doctor. It needs a wide range of
investigations and there is a debate about the lines of management. Till
now the pregnancy rate after ICSI cycle in RIF patients still
unsatisfactory.
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