Implantation failure

Occurs when pregnancy does not develop after 2 transfers of 2 good-quality embryos, whether fresh or vitrified.

When this happens, it’s important for the patient to undergo a process that helps promote embryo implantation in her endometrium.

The causes that can prevent the proper implantation of embryos are varied and result from numerous factors that need to be studied. For example:

• Uterine factors
• Hormonal factors
• Endometrial factors
• Immunological factors
• Autoimmune diseases, endometriosis, infectious diseases…
• Quality of gametes and embryos
• etc…

The techniques and treatments we develop at UR Crea to achieve pregnancy after several implantation failures include the following:

Selection of the best-qualified embryos free of genetic or chromosomal abnormalities:
Genetic analyses of embryos allow our embryologists to select only those embryos that are healthy and most likely to result in pregnancy and the birth of a healthy baby.

Thrombophilia studies:
Sometimes it’s necessary to conduct a study to detect the presence of coagulation disorders in patients with implantation failures.

Diagnosis of endometriosis:
Endometriosis is one of the main infertility problems in patients today. We must rule out the presence of this disease or diagnose the best treatment.

Vaginal ultrasounds:
Serial vaginal ultrasounds are performed to increase estrogen levels (both orally and vaginally), administer vasodilators (sildenafil, pentoxifylline), and factors stimulating granulocyte colonies.

In all these cases, the diagnosis must be personalized, and appropriate measures taken. As a supportive treatment, we sometimes use:

• Immunological studies of patients: Study of the immune status of patients with the aim of promoting embryo implantation. In these cases, we use:
• Use of anticoagulants, especially subcutaneous heparin, and acetylsalicylic acid.
• If hydrosalpinx is detected in the fallopian tubes, it may be necessary to consider the removal or tubal occlusion.
• Improvement of endometrial stimulation to promote implantation.
• Care and monitoring of TSH and T4 levels and vitamin D concentrations.
• Care and monitoring of progesterone levels during endometrial preparation and the embryonic phase.
• Use of endometrial PRP.

In cases where the problem lies with the male factor, it is advisable to perform a selection of the best-qualified sperm prior to fertilization. In our clinics, this process is usually carried out using the MACS technique, which allows us to eliminate unsuitable sperm.

Similarly, in our egg donation program and in cases of implantation failure in general, we perform embryo transfers at blastocyst stages to improve implantation for better endometrial selection and synchronization.

In the case of frozen embryo transfers and in women of advanced age (over 40), we perform assisted hatching.