Recurrent IVF Failure

Causes of Recurrent IVF Failure

Advanced Maternal Age

As women age naturally, their reproductive capacity declines and fertility rates drop. Advanced maternal age is generally considered to be 38 years and older.

Declining Egg Quality

As a woman's age advances, the number and quality of eggs in her ovaries decrease. This affects fertilization and embryo development, reducing the number of genetically normal embryos. A decline in egg quality increases the risk of recurrent IVF failure.

Diminished Ovarian Reserve

As a woman's age advances, her ovarian reserve (the number of eggs in the ovaries) decreases. A reduced ovarian reserve lowers the number of eggs retrieved during an IVF attempt. As the number of eggs decreases, the number of embryos formed also decreases. This increases the likelihood of recurrent IVF failure.

Increased Genetic Abnormalities

At advanced age, the likelihood of embryos forming with genetic abnormalities increases. Embryos with genetic abnormalities often fail during implantation, so pregnancy does not occur, or the pregnancy may end in early miscarriage.

Increased Risk of Complications

Advanced maternal age brings with it many potential issues during pregnancy. This also increases the risk of recurrent IVF failure.

Tubal Problems

The condition of the fallopian tubes is an important factor during IVF treatment

• Hydrosalpinx: This is a condition where fluid accumulates due to blockage at the ends of the tubes. Because of the inflammation caused by hydrosalpinx, the embryo cannot implant in the uterus and a successful pregnancy cannot occur. IVF treatment should not proceed, and transfer should not be performed, until hydrosalpinx has been treated.
• Risk of Ectopic Pregnancy: The risk of ectopic pregnancy (pregnancy outside the uterus) increases in tubes whose normal structure and function are impaired. If the embryo implants somewhere outside the uterus, a healthy pregnancy cannot occur. Ectopic pregnancies can also lead to recurrent IVF failure in treatment.

Hormonal Imbalances

Hormonal imbalances negatively affect ovulation, thickening of the endometrial lining, and implantation of the embryo in the uterus. Conditions such as luteal phase defect can cause insufficient hormone levels, leading to recurrent IVF failure. Underactive or overactive thyroid function can also increase the risk of recurrent IVF failure.

Genetic Factors

These play an important role in embryo development, the implantation process, and the continuation of pregnancy.

• Genetic Abnormalities: Embryos with genetic abnormalities may fail to implant or may end in miscarriage. Genetic abnormalities can occur in chromosome number and structure or in gene mutations. Couples experiencing recurrent IVF failure should be evaluated for genetic abnormalities.
• Genetic Carrier Status: In couples who carry genetic diseases, the healthy development of the resulting embryos and the pregnancy process may be negatively affected. When carrier status for a genetic disease is identified, embryos should undergo genetic testing with PGT.

Immunological Factors

The immune system enables the body to mount an immune response against foreign substances, and when the body's immune system is disrupted, it may prevent the embryo from implanting in the uterus. In some cases, imbalances or excessive reactions in the immune system can also reduce the chances of success in IVF treatment.

• Autoimmune Diseases: Autoimmune diseases occur when the body mounts an immune response against its own tissues. Autoimmune diseases can have negative effects on the reproductive system and can lead to recurrent IVF failure. Autoimmune conditions such as antiphospholipid syndrome can cause blood clotting and implantation problems.
• Immunological Disorders and Inflammation: Immunological disorders can cause inflammation and tissue damage. This can negatively affect endometrial quality and lead to implantation failure.

What Tests Should Be Done for Couples Experiencing Recurrent IVF Failure?

Genetic tests:

• Karyotype analysis: Examination of the couple's chromosome structure.
• Preimplantation Genetic Testing (PGT): Screening of embryos for chromosome number and structure
• Carrier screening tests: Screening the couple for hereditary diseases

Hormonal tests

• FSH (follicle-stimulating hormone) and LH (luteinizing hormone) levels: To assess ovulatory function and reserve.
• Estradiol (E2), progesterone and prolactin levels: To assess hormonal balance
• Thyroid hormone testing: Assessment of thyroid function with TSH, T3, and T4.

Immune system tests

• Antibody screening: To measure immune system responses.
• Antiphospholipid antibody testing: To detect blood clotting and possible implantation problems.

Implantation and uterine assessment

• Ultrasound or MRI: to evaluate uterine abnormalities (fibroids, adenomyosis)
• Hysteroscopy: Used to evaluate the inner surface of the uterus and to treat conditions such as polyps and septum.
• Endometrial biopsy: Performed to obtain samples for pathological analysis of endometrial tissue or for the endometrial receptivity (ERA) test.

Embryo quality and development assessments

• Embryoscope (time-lapse imaging): Evaluation of embryo morphology: analysis of embryo structure and development

What Treatment Options Are Available for Recurrent IVF Failure?

Preimplantation Genetic Testing (PGT)

PGT is a method used to select healthy embryos through genetic testing, increasing the chances of successful implantation.

Embryo Selection and Transfer Techniques

• Blastocyst transfer: Allowing embryos to develop to the blastocyst stage (days 4-5-6) before transfer increases pregnancy success rates compared to cleavage-stage, i.e. day-3, embryo transfer.
• Assisted hatching technique: Opening the embryo's outer shell before transfer helps increase the chances of implantation.
• Morphological assessment for embryo selection: Monitoring embryo development using an embryoscope or selecting embryos with the help of artificial intelligence methods.
• Improving transfer techniques and performing a trial (mock) transfer before the actual embryo transfer procedure

Endometrial Preparation

Depending on the patient's clinical findings, endometrial preparation may be done without medication during a natural menstrual cycle, or with the estrogen hormone in what we call HRT (hormone replacement therapy) preparation; luteal phase support with progesterone hormone supplementation increases the chances of implantation.

Immune Modulation

Treatments that regulate the immune system using immunosuppressive medications may help increase the chances of implantation.

Thrombophilia Treatment

For the treatment of thrombophilia conditions such as antiphospholipid syndrome, low-dose aspirin and heparin use may help increase the chances of implantation.

Tissue Compatibility and Immunological Treatments

Regulating the immune system through immunological treatments such as intralipid therapy and immunoglobulin therapy may help increase the chances of implantation.

Alternative Reproductive Methods

Alternative reproductive methods, such as using donor eggs, donor embryos, or gestational surrogacy, can help couples experiencing recurrent IVF failure.

Recurrent IVF Failure in Antalya

Couples experiencing recurrent IVF failure should consult an IVF specialist experienced in this field. The specialist will evaluate the couple's situation and determine the most appropriate treatment method.