Causes of Recurrent IVF Failure
Advanced Maternal Age
As women age, their natural reproductive capacity declines and fertility rates decrease. Advanced maternal age is generally defined as 38 years and older.
Decreased Egg Quality
With increasing age, both the number and quality of eggs in the ovaries decline. This negatively affects fertilization and embryo development, reducing the number of genetically normal embryos. A decline in egg quality significantly increases the risk of recurrent IVF failure.
Decreased Ovarian Reserve
As maternal age advances, ovarian reserve (the number of eggs in the ovaries) decreases. A reduced ovarian reserve leads to fewer eggs retrieved during IVF cycles, resulting in fewer embryos. As the number of embryos decreases, the likelihood of recurrent IVF failure increases.
Increased Genetic Abnormalities
At advanced maternal age, the probability of embryos with genetic abnormalities increases. Genetically abnormal embryos often fail during implantation or result in early pregnancy loss.
Increased Risk of Pregnancy Complications
Advanced maternal age is associated with a higher risk of pregnancy-related complications, which may contribute to recurrent IVF failure.
Tubal Factors
The condition of the fallopian tubes plays a critical role in IVF treatment.
- Hydrosalpinx:
A condition characterized by fluid accumulation due to blockage at the end of the fallopian tubes. In hydrosalpinx, inflammation prevents embryo implantation and successful pregnancy. IVF treatment and embryo transfer should not be performed without treating hydrosalpinx. - Risk of Ectopic Pregnancy:
Damaged or dysfunctional fallopian tubes increase the risk of ectopic pregnancy. If an embryo implants outside the uterus, a healthy pregnancy cannot occur, and this may contribute to recurrent IVF failure.
Hormonal Imbalances
Hormonal imbalances negatively affect ovulation, endometrial thickening, and embryo implantation. Conditions such as luteal phase defect, as well as hypo- or hyperthyroidism, can increase the risk of recurrent IVF failure.
Genetic Factors
Genetic factors play a crucial role in embryo development, implantation, and pregnancy continuation.
- Genetic Abnormalities:
Embryos with chromosomal or gene-related abnormalities may fail to implant or result in miscarriage. Couples with recurrent IVF failure should be evaluated for genetic abnormalities. - Genetic Carrier Status:
Couples who are carriers of genetic diseases may experience impaired embryo development and pregnancy outcomes. In such cases, embryos should undergo genetic testing using PGT.
Immunological Factors
The immune system protects the body against foreign substances. When immune regulation is impaired, it may prevent embryo implantation. In some cases, immune system overactivity can reduce IVF success rates.
- Autoimmune Diseases:
Autoimmune conditions cause the immune system to attack the body’s own tissues and may negatively affect reproductive function. Conditions such as antiphospholipid syndrome can lead to clotting disorders and implantation failure. - Immune Disorders and Inflammation:
Immune dysregulation may cause inflammation and tissue damage, negatively affecting endometrial quality and leading to implantation failure.
Which Tests Should Be Performed for Couples With Recurrent IVF Failure?
Genetic Tests
- Karyotype analysis: Evaluation of chromosomal structure in both partners.
- Preimplantation Genetic Testing (PGT): Screening embryos for chromosomal number and structural abnormalities.
- Carrier screening tests: Assessment for inherited genetic disorders.
Hormonal Tests
- FSH and LH levels: Evaluation of ovulation function and ovarian reserve.
- Estradiol (E2), progesterone, and prolactin levels: Assessment of hormonal balance.
- Thyroid hormone tests: TSH, T3, and T4 to evaluate thyroid function.
Immune System Tests
- Antibody screening: Evaluation of immune responses.
- Antiphospholipid antibody testing: Detection of clotting disorders and implantation-related issues.
Uterine and Implantation Assessment
- Ultrasound or MRI: Evaluation of uterine abnormalities such as fibroids and adenomyosis.
- Hysteroscopy: Assessment and treatment of intrauterine conditions such as polyps or septum.
- Endometrial biopsy: Sampling for pathological analysis or endometrial receptivity array (ERA) testing.
Embryo Quality and Development Evaluation
- Embryoscope: Time-lapse monitoring for embryo morphology and developmental analysis.
Treatment Options for Recurrent IVF Failure
Preimplantation Genetic Testing (PGT)
PGT allows the selection of genetically healthy embryos, increasing implantation rates and pregnancy success.
Embryo Selection and Transfer Techniques
- Blastocyst transfer:
Transferring embryos at the blastocyst stage (days 4–6) improves pregnancy rates compared to cleavage-stage (day 3) transfer. - Assisted hatching:
Opening the zona pellucida before transfer may enhance implantation. - Morphological embryo assessment:
Embryoscope monitoring or artificial intelligence-based embryo selection methods. - Improved transfer techniques and mock embryo transfer prior to the actual procedure.
Endometrial Preparation
Depending on clinical findings, endometrial preparation may be performed in a natural cycle or using hormone replacement therapy (HRT). Luteal phase support with progesterone improves implantation success.
Immune Modulation
Immunosuppressive therapies may help regulate immune responses and improve implantation rates.
Thrombophilia Treatment
Low-dose aspirin and heparin therapy may be used in thrombophilic conditions such as antiphospholipid syndrome to enhance implantation success.
Immunological and Tissue Compatibility Treatments
Treatments such as intralipid infusion and immunoglobulin therapy may help regulate immune responses and improve implantation outcomes.
Alternative Reproductive Options
Options such as donor eggs, donor embryos, or gestational surrogacy may be considered for couples with recurrent IVF failure.
Recurrent IVF Failure in Antalya
Couples experiencing recurrent IVF failure should consult an experienced fertility specialist. A personalized evaluation allows the most appropriate treatment strategy to be determined.