Recurrent Implantation Attempts
Finding a path forward after disappointment.
About Recurrent Implantation Attempts
RIF refers to failure of implantation despite multiple embryo transfer attempts. About 10 to 20% of patients who undergo IVF fail to conceive after the transfer of 2-3 genetically tested or good quality embryos. Successful implantation requires not only a genetically and metabolically healthy embryo, but also a receptive uterine lining (endometrium) and a conducive hormonal and immune environment. Although implantation failure is often related to embryo quality, there are other uterine, hormonal, and/or immune factors that may contribute to difficulty with implantation. A comprehensive approach to this problem is necessary to ensure that all factors are optimized for future success.
Our RIF program offers a thorough, comprehensive, and compassionate approach to this problem. Our physicians specialize in the diagnosis of RIF, assessment of potential barriers to implantation, and optimization of embryonic and uterine factors to improve future outcomes. We understand the physical and emotional strain of RIF and strive to help our patients through these obstacles.
Your Journey to Overcome RIF Begins Here
No two patients are alike and the reasons for recurrent implantation attempts can vary considerably. Our job is to explore possible avenues that would explain implantation failure and develop a specific plan to address the issue. Below we outline a number of the investigations you can expect from your fertility doctor. Many patients come to Markham Fertility Centre for our unique Immune Program. Your doctor will explore all avenues.
Consultation
The first step is identifying the problem. Our physicians will take a full history of your IVF treatments to date to understand how many embryos you have transferred and what their quality has been. They will determine if you qualify for testing and treatment related to RIF.
TESTING - Embryos
The most common reason for failed implantation is genetic aneuploidy of the embryo, which is an abnormal number of chromosomes in the embryo’s cells. Therefore, if the failed embryo transfers in the past were not genetically tested, we often recommend preimplantation genetic testing for aneuploidy (PGT-A) if patients are doing additional IVF treatment.
TESTING - Pelvic imaging and uterine cavity assessment
Through our collaboration with Care Imaging, we provide state of the art, high resolution pelvic ultrasonography services. This enables us to get a detailed survey of pelvic anatomy, and assess for anatomic issues, uterine anomalies, and endometriosis. We also can perform 3 dimensional sonohysterogram and hysteroscopy to assess and optimize the uterine cavity.
Testing - Hormones
Extensive hormonal testing is performed to ensure that the hormonal environment is conducive to embryo implantation and pregnancy.
Testing - Uterine receptivity
Your doctor will explore uterine receptivity tests with you and discuss if a uterine receptivity test is for you.
Testing - Uterine microbiome and infection screening
Endometrial biopsy-based screening might be offered to rule out abnormal bacterial colonization of the uterus.
Testing - Immune system profiling
Immune factors like Natural Killer cells and pro-inflammatory cytokines have been associated with implantation failure. We offer testing of these factors to see if the immune system is conducive to embryo implantation and pregnancy.
Treatment
Patients with RIF who have not previously done embryo genetic screening should consider IVF with PGT-A. If any uterine structural abnormalities are noted, the physicians at MFC are trained reproductive surgeons who can address these issues surgically. If standard treatments for implantation failure have failed, MFC offers empiric/or experimental treatments – including personalized endometrial preparation protocols, uterine infection therapies, and reproductive immune treatments to optimize the uterine environment for implantation.
