Infertility is a widespread problem that affects millions of couples globally, with a noticeable impact on around 8%–10% of couples. However, in India specifically, the prevalence of infertility is even higher, affecting an alarming number of 15 to 20 million couples, which accounts for approximately 25% of the global burden of infertility. Developing countries, including India, face significant challenges in addressing this issue, as highlighted by a report from the World Health Organization (WHO), which indicates that 1 in every 4 couples in such regions experiences infertility.
Infertility is a global issue that has a significant impact on millions of couples worldwide, with approximately 8%–10% being affected. However, the prevalence of infertility in India is even more pronounced, with a concerning number of 15 to 20 million couples accounting for approximately 25% of the global burden of infertility. Developing countries, including India, encounter significant challenges in tackling this problem. A report from the World Health Organisation (WHO) emphasises that 1 in every 6 couples in these regions experiences infertility, underscoring the magnitude of the issue.
IVF has become a well-established and widely accepted technology for addressing infertility issues. Over the years, advancements in drugs, lab equipment, culture, and media have contributed to its safety, efficiency, and reproducibility. Since the birth of the first IVF baby in 1978, the field has made significant progress, and the success rates of IVF have exceeded 50 percent in recent times. However, it is important to note that IVF does not guarantee success in every case. Some couples may experience Repeated implantation failure (RIF) despite undergoing multiple IVF cycles. This can be emotionally and financially draining for couples who have put in significant effort but have been unable to achieve pregnancy. RIF is typically defined as the transfer of four or more good-quality embryos without achieving pregnancy or three failed transfers with good-quality embryos.
In vitro fertilisation (IVF) has emerged as a well-established and widely accepted technology for addressing infertility concerns. Advancements in drugs, laboratory equipment, and culture and media have played a crucial role in enhancing the safety, efficiency, and reproducibility of IVF over the years. Since the birth of the first IVF baby in 1978, notable progress has been made, resulting in success rates exceeding 50 percent in recent times. However, it is important to acknowledge that IVF outcomes cannot be guaranteed in every case.
Dr. Meenu Vashisht Ahuja, Consultant, Birla Fertility and IVF, shares, “Despite undergoing multiple IVF cycles, some couples may encounter a condition known as repeated implantation failure (RIF). This experience can be emotionally and financially taxing for couples who have invested significant effort without achieving pregnancy. RIF is typically defined as the transfer of four or more high-quality embryos without successful implantation or three unsuccessful transfers involving good-quality embryos.”
To diagnose repeated IVF failure, a thorough evaluation of various factors is necessary, including medical history, hormonal assessment, embryo evaluation, uterine assessment, and consideration of immunological and genetic factors. Understanding the underlying causes enables the development of a personalised treatment plan, increasing the chances of success for couples facing this challenge. Consulting with a fertility specialist is crucial, as they can provide guidance and support throughout the diagnostic process.
Experiencing a failed IVF cycle does not indicate the absence of future pregnancy possibilities. It is important to investigate the reasons behind the failure and modify the treatment accordingly to improve the chances of success in subsequent cycles. Incorporating recommended procedures such as laser-assisted hatching, microfluidics, pre-implantation genetic testing, injecting platelet-rich plasma into the uterine cavity, or supplementing the diet with antioxidants can enhance the outcomes. Many patients have achieved conception after 4-5 IVF cycles with the appropriate interventions tailored to their specific needs.
There are many factors that can contribute to repeated IVF failure, including
Poor-quality embryos: Embryos that are not chromosomally normal or that have other genetic defects may not be able to implant.
Uterine abnormalities: Problems with the uterus, such as polyps, fibroids, or adhesions, can make it difficult for embryos to implant.
Immunological factors: In some cases, the woman’s immune system may attack the embryos, preventing them from implanting.
Other factors: Other factors that can contribute to repeated IVF failures include age, smoking, and obesity.
1. Comprehensive medical evaluation
A thorough medical evaluation is the first step in diagnosing repeated IVF failure. This may include:
a. Review of medical history: The medical history of both partners, including any previous fertility treatments, pregnancies, or miscarriages, is carefully assessed.
b. Hormonal assessment: Hormone levels, such as follicle-stimulating hormone (FSH), luteinizing hormone (LH), progesterone, and thyroid-stimulating hormone (TSH), are measured to evaluate ovarian function and hormonal imbalances.
c. Ultrasound and imaging studies: Transvaginal ultrasound is performed to assess the structure and health of the uterus, ovaries, and fallopian tubes. Additional imaging studies, such as hysterosalpingography (HSG), may be done to evaluate the uterine cavity and fallopian tube patency.
2. Embryo evaluation
The quality and viability of embryos play a critical role in the success of IVF. Therefore, an evaluation of the embryos is essential. This can involve:
a. Embryo grading: Embryos are assessed based on their morphology, stage of development, and cell division patterns. High-quality embryos have a better chance of implantation and pregnancy.
b. Genetic testing: Preimplantation genetic testing (PGT) may be recommended to screen for chromosomal abnormalities or genetic disorders in embryos before transfer.
3. Uterine assessment
The uterus provides the environment for embryo implantation and development. Therefore, it is crucial to evaluate the uterine factors that may contribute to repeated IVF failure, including:
a. Hysteroscopy: A minimally invasive procedure that allows direct visualisation of the uterine cavity to detect abnormalities such as polyps, fibroids, or adhesions.
b. Endometrial receptivity testing: Assessing the receptivity of the endometrium, the lining of the uterus, through biopsy and molecular analysis to determine the optimal timing for embryo transfer.
4. Immunological and genetic factors
In some cases, repeated IVF failure may be attributed to immunological or genetic factors. Additional tests may be recommended to evaluate:
a. Immunological factors: Autoimmune disorders, such as antiphospholipid syndrome (APS) or immune-mediated implantation dysfunction, can impact embryo implantation and pregnancy success.
b. Genetic factors: Genetic abnormalities in either partner can affect fertility and embryonic development. Genetic testing may be recommended to identify any underlying genetic issues.
