Embryo implantation definition
Causes of implantation failure
Recurrent implantation failure (RIF)
Symptoms of implantation failure
Embryo implantation is the process by which the embryo, which is about 7 days old since fertilization, attaches to the endometrium and begins gestation. For the implantation to happen, the proper uterine environment needs to be created, where the endometrium and embryo can interact. That is not happening in all menstrual cycles even if you are having unprotected sex. It is also not 100% happening in assisted reproduction cycles, even though fertilization has taken place in the laboratory and good-quality embryos are transferred.
IVF being the most common assisted reproductive technique, has given hope to many infertile couples, who couldn’t conceive naturally. The main key of the process you need to remember about IVF is that fertilization happens outside the woman’s body, where an egg is combined with sperm in the laboratory, before the fertilized egg returns to the uterus.
When IVF is successful, the fertilized egg implants in the uterus and becomes a viable pregnancy. The implantation stage lasts several days and if it fails it means that the egg didn’t attach and exited the woman’s body.
It is not always easy for fertility specialists to determine what caused the implantation failure but usually, it happens for one of the below reasons.
Embryo quality: There are times when the quality of the embryo isn’t good enough for successful implantation, with some defects not to be apparent in the lab but still preventing the embryo from becoming viable. This may have to do with the age or quality of the eggs or sperm, where at the same time many unknown factors can also contribute to poor embryo quality.
Uterine problems: Any malformations in the uterus can result in recurrent implantation failure. Some women are born with an anatomically different uterus while other problems can be acquired during one’s lifetime, such as uterine fibroids and other issues that can impact your uterine health.
Chromosomal issues: Some embryos may have chromosomal abnormalities that make it difficult or impossible for them to implant in the uterus. Again here, age is playing an important role as chromosomal issues are more likely to develop at later ages, impacting IVF success.
Lifestyle factors: Leading a healthy lifestyle can positively influence implantation and IVF cycles. Smokers have a much higher likelihood of implantation failure or early pregnancy loss. Maintaining a healthy weight may also help you to become pregnant through IVF. Finally, stress can hurt your chances of successful implantation so maintaining a steady mental health state is crucial.
In a natural pregnancy, it’s believed that somewhere between 40 to 60% of embryos are lost during the period between fertilization and birth. However, all of these aren’t the result of failed implantation.
During IVF, approximately 5% will fail during at least two consecutive attempts. Nearly 75% of these failed attempts are thought to be due to implantation failure.
RIF occurs when women have had three or more failed IVF attempts with good-quality embryos. Sperm analysis, preimplantation genetic screening (PGS), and endometrial receptivity should be considered and evaluated while RIF happens. Also, ovarian stimulation, hysteroscopy, and sperm DNA fragmentation test are three common ways to evaluate why implantation fails.
Endometrial receptivity test: It is based on a possible desynchronisation between the endometrium and the embryo as a consequence of the displacement of the window of implantation. However, there is no evidence for its systematic recommendation at present. In cases of absence of euploid embryos or embryo blockage, egg donation is proposed as a solution to the embryonic cause of RIF.
Ovarian stimulation: in cases of hyper-responsiveness to ovarian stimulation, it is recommended to avoid fresh transfer, freezing the embryos for a deferred cycle.
Hysteroscopy: It should be performed when there is suspicion of pathologies that can be corrected by this technique, such as septate uterus, subseptate uterus, and T-shaped uterus. Correction is also recommended in the case of endometrial synechiae or polyps as well as submucous myomas or intramural myomas that deform the uterine cavity.
Sperm DNA fragmentation test: This type of testing has been used to attain more in‐depth knowledge about sperm quality due to the critical function of sperm DNA integrity for healthy embryonic development and successful reproductive outcome. One thing you should notice is that men can have a normal sperm count, motility, and morphology, and still have large amounts of sperm DNA damage. Interestingly, the egg has some capacity to repair damaged sperm DNA upon fertilization, however, scientists believe there may be a threshold of DNA damage beyond the repair capacity of eggs.
Methods of sperm DNA fragmentation testing:
The last one is the most studied and used DNA test.
The results of testing are divided into the following categories:
For all the above testing you should consult with your fertility specialist, the one that has already monitored your fertility journey, and knows what is best according to your specific medical needs.
In general, successful implantation leaves some subtle signs in a woman’s body, such as implantation bleeding, stomach cramps and bloating, and breast tenderness. At the same time, signs of unsuccessful implantation may have similarities with the above signs. A negative pregnancy test though, is the one definite way to understand that the implantation has failed. There are also times that we may think that implantation has been successful, only to later find out that it wasn’t. This happens with chemical pregnancies, ectopic pregnancies, and missed miscarriages.
As we mentioned above in the causes, lifestyle behaviors can play an important role in preventing an implantation failure. Avoiding smoking and excessive use of alcohol for both female and male partners is the first thing that doctors recommend. Maintaining a healthy weight can also impact a woman’s ability to get pregnant during IVF. Either being overweight or underweight can cause problems with implantation. Eating healthy, exercising regularly, and maintaining a steady mental health state during your fertility journey will help smoothen the process.
Looking to perform your fertility treatment abroad?
Beginning your fertility journey is not an easy decision and should not be treated lightheartedly. Also, assisted reproductive techniques are pricey, especially in countries such as the US and USA. On the other hand, Greece is considered a top IVF destination because of the lower prices, the good legislation, the top-notch clinics, and the new IVF age limit of 54 years old for women. The previous age limit was 52 years old (one of the highest in Europe) and now with the latest government act of May 2022, it is raised to 54 years old. That extends hope for more women and couples wishing to conceive. IVF cost in Greece varies between 3 and 4k euros, depending on the doctor who performs it. MEDIPASS cooperates with 8 fertility doctors and clinics, in three different parts of the country, Athens, Thessaloniki, and Crete.
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