How to prevent IVF failure

Four to 17 per cent of Indian couples are diagnosed as infertile. Infertility is a condition characterised by the failure to establish a clinical pregnancy after 12 months of regular, unprotected sexual intercourse.

However, only one per cent of the affected couples have opted for IVF (in-vitro fertilisation) or other treatments that can help conceive. The uptake of Assisted Reproductive Technology (ART) for conceiving is on the rise.

In fact, 40 years since the world's first IVF baby was born, over 8 million IVF babies have been born worldwide.

However, there are instances when IVF cycles could repeatedly fail. Repeated IVF Failure (RIF) refers to cases in which women had three failed in vitro fertilization (IVF) attempts with good quality embryos.

There are multiple risk factors for recurrent IVF failure including advanced maternal age, smoking status of parents, elevated body mass index, and stress levels.

Dr Chandana Lakkireddi, fertility consultant, NOVA IVI Fertility, Hyderabad says, "Implantation dysfunction is a common cause of repeated "unexplained" IVF failure with good embryos.

This is especially the case in young ovulating women who have normal ovarian reserve and have fertile partners. Successful embryo implantation depends on a well-functioning endometrium as well as a normal healthy embryo.

For IVF procedures, it is critical to ensure the adequacy of the embryo and endometrium individually. This process might be hampered if either of these variables is defective".

Reasons for repeated IVF failure:

With an average success rate of 50 per cent, there are several couples who experience failed IVF treatment.

The most common causes of RIF are generally classified as maternal or embryological factors. Some of the most common reasons for IVF failure are:

Implantation failure:

Implantation failure is commonly caused due to uterine health. If the endometrium (lining of the uterus) is not thick enough for the embryo to be attached or if it does not provide the necessary nutrients for the embryo to develop in the first few days, the embryo fails to implant to the uterine wall.

A weak endometrium is often a result of conditions like fibroids, endometrial polyps, congenital anomalies, intrauterine adhesions, hydrosalpinges.

Most health care professionals are looking for a uterine lining to be greater than 8mm when a patient is having fertility treatment, however optimal would be considered 11-12 millimetres

Age related:

Maternal age is the most important variable in predicting implantation. The ovarian reserve of a woman tends to decline sharply after her mid-30s.

Advanced maternal age is not only associated with increase in embryo aneuploidy but also there is a parallel decline in ovarian reserve and response to gonadotropin stimulation.

Embryo quality

The health of the embryo depends on the quality of the gametes; i.e the oocyte and sperm quality, in cases with advanced maternal age the oocyte quality can be compromised affecting implantation and success of IVF.

If the quality of the Embryo is compromised due to alterations in the number of chromosomes or if the shell surrounding the embryo is thin, of in instances where the cells that are developing in the embryo itself are irregular or when there is a significant degree of cell debris around the embryo (known as fragmentation) it is thought that implantation could be compromised

DNA fragmentation:

Sperm DNA integrity is vital for successful fertilisation, embryo development, pregnancy, and transmission of genetic material to the offspring.

DNA fragmentation is the most frequent DNA anomaly present in the male gamete that has been associated to poor semen quality, low fertilisation rates, impaired embryo quality, and pre-implantation development and reduced clinical outcomes in assisted reproduction procedures.