Recurrent IVF Failure

Repeated IVF failures wear a person down, in the body and in the mind both, and there is no pretending otherwise. But another cycle that did not work does not mean pregnancy is off the table for you. More often than not, once we find the reason it kept failing, the chances in the next attempt improve, and that is really the whole point of stopping to look.

At TheFertilife, Dr. Anshika Lekhi works through a recurrent IVF failure in a structured way, on the evidence and nothing else. We do not simply run the same protocol again, and we do not reach for a shelf of add-on treatments the moment things go wrong. The job is to find the cause that is keeping the embryo from implanting, and fix that.

What is Recurrent IVF Failure?

Is there one agreed definition for this? There is not. Most of us in fertility begin to call it recurrent failure when pregnancy has not happened after a certain point, and that point is roughly this.

• Two or more transfers of good-quality embryos
• Or several IVF cycles where a number of embryos were transferred

Honestly the exact count matters less than the pattern. Once the same thing keeps repeating, that is the signal to stop and investigate, before you pour another cycle on top of it.

What Causes Recurrent IVF Failure?

Several things can be behind repeated implantation failure.

Embryo Chromosomal Abnormalities

The commonest reason, by far, is that the embryo itself carries a chromosomal abnormality. An embryo can look perfectly healthy down the microscope and still not be genetically normal enough to hold on and implant. In some couples we bring in PGT-A, that is preimplantation genetic testing, to pick out the chromosomally normal embryos before transfer.

Uterine Abnormalities

Then there is the uterus. Problems sitting inside it get in the way of implantation, and these are the usual ones.

• Endometrial polyps
• Fibroids
• Uterine adhesions, which is scar tissue
• A uterine septumUterine eubiosis 

We pick these up on a hysteroscopy or on detailed imaging, and the good part is that most of them can be corrected before you go into another cycle.

Endometrial Receptivity

For an embryo to implant it has to go in while the uterus is actually ready to receive it, and that ready stretch is called the window of implantation. In some women that window sits a little earlier or later than expected. Here, in carefully chosen cases, endometrial receptivity testing can help us time the transfer to the individual, though I still believe that not every patient needs this test.

Sperm Factors

Sperm matters too. Poor sperm quality can pull down the quality of the embryos in some couples. Now, we do not run sperm DNA fragmentation testing on everybody, that is not needed, but where history points to it we will.

Antiphospholipid Syndrome

There is also antiphospholipid syndrome, an autoimmune clotting disorder that has been tied to implantation failure and to pregnancy loss. This one we take seriously, because if it is actually present, treating it with low-dose aspirin and heparin has solid evidence behind it.Real evidence.

Do Immune Therapies Really Help?

Nearly every couple who walks in has read about these somewhere.

• IVIG
• Intralipid infusions
• Steroids
• The other immune therapies doing the rounds

Here we have to be straight with you. For unexplained recurrent IVF failure the guidelines do not recommend these as a routine thing, and the reason is simple, the evidence for them is thin and it does not hold together. In a very selected patient, with a real confirmed medical reason, one of these can have a place. For everybody else it is not standard treatment, whatever the internet suggests, and we will not put you on it just to look like we are doing something. We will do the test and then do the needful.

How Is Recurrent IVF Failure Investigated?

1. Dr. Anshika Lekhi goes through each case in order, rather than firing off every test that exists. The workup tends to run like this.
2. First we go back over your previous IVF cycles, properly, and look for a pattern in the stimulation, the fertilisation, how the embryos developed, the transfer itself.
3. The uterus gets assessed next, on hysteroscopy or a detailed 3D ultrasound, so nothing structural slips past us.
4. Is a chromosomal problem the suspicion? Then carrier screening, karyotyping or PGT-A comes in.
5. Endometrial receptivity testing, where it fits, and it does not fit everyone.
6. And blood tests where your history calls for them, antiphospholipid syndrome being the one we check for most often.