What is the meaning and reasons behind Implantation Failure? - Dr. Nirmala T S

Going by the definition of recurrent implantation failure, it is nothing but the failure of the women to implant the embryos which are of good quality after having transplanted into the uterus which means the embryo has not gone upto the stage of giving her a positive pregnancy result or detecting a gestational sac or a viable pregnancy by the ultrasound. So want are the reasons behind a recurrent implant failure. When we say that we are transferring good quality of embryos, why should they go without implanting to the uterus majorly if you look at the reason 80% of the times, it is the embryo that contributes to a failure. 10 to 15 % of the times it is the uterus which fails an implantation, Very small contribution is form the sperm, 2.5 to 5%. So when we say that a quality of embryo being good, how is it we assess the quality? It is the morphological way how we assess. In the sense we look at the way the embryo is dividing into daughter cells, the way the material gets incorporated or segregated or realigned into the daughter cells without getting fragmented. So it is more of a morphological groups way of saying that the embryo is not normal. Ewe need to understand that even though the embryo may look perfectly normal, exactly like what is being described in the text books, we still find that these embryos may end to be genetically can turn out to be absolutely chromosomally abnormal, what we call as aneuploidy status. So out of a set of embryos that have been generated following a procedure of IVF, 64 % to 68% of these embryos tend to be wasted embryos or chromosomally abnormal, to be discarded. Now if that is not assessed and not understood, time and again the so called normal looking embryos are getting transferred into the ureters, and we are puzzled to why are they not getting implanted, looking at the uterine factors, there are certain factors that can impede. The implantation could be some space of occupying lesions in the uterus like a fibroid a polyp, sometimes intrauterine infections which predispose to formation of adhesions or septum inside the uterus. Sometimes these infections if they are sexually transmitted and also tuberculosis which is very very rampant in India, especially in South India can affect the lining of the uterus to such an extent that the blood flow, the thickness, the texture of the endometrium is altered and it just doesn’t favour a nidation process. As far as a sperm , a very poor sperm morphology, with certain sperm factors that predispose to the formation of increase in the reactive oxygen species leading to the damage of the sperm head and that is what we test by the DNA fragmentation index. If that value is pretty high, there notes that there is some amount of sperm head damage and the sperm head contains the entire set of chromosomes and it is the sperm head alone which gets into the egg during the process of fertilisation. The neck and the sperm tail gets discarded. What happens when there is a damage to that? Definitely it can predispose to the formation of an abnormal embryo which doesn’t have the potency to continue developing. Many of the times the embryos are selected on the second day or on the third day or of it is an extended culture may be on to the day 5 or day 6. So what happens is the embryo could continue to develop till such a stage and beyond which the embryo may lose its own potentiality to develop and that could also be one of the major causes of an implantation failure.

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