What Is Recurrent IVF Failure?

Recurrent implantation failure refers to the inability to achieve pregnancy after multiple IVF attempts. It is typically defined as failure to achieve pregnancy after three or more consecutive IVF cycles.

1. Advanced Maternal Age: As women naturally age, their reproductive capacity declines and fertility rates decrease. Advanced maternal age is generally considered to be 38 years and older.

Declining Egg Quality: At an advanced age, women have fewer and lower-quality eggs in their ovaries. This reduces the number of healthy embryos suitable for fertilization and development, increasing the risk of repeated failure.
Reduced Ovarian Reserve: With age, the ovarian reserve (number of remaining eggs) decreases. A reduced reserve lowers the number of viable eggs in each IVF attempt, increasing the likelihood of failure.
Increased Genetic Abnormalities: At advanced age, the likelihood of embryos having genetic abnormalities increases. These embryos may fail to implant or result in early miscarriage.
Higher Risk of Complications: Advanced maternal age increases the risk of complications during pregnancy, which may affect IVF success.
2. Tubal Factor (Tube Problems): The condition of the fallopian tubes is an important factor during IVF treatment.

Hydrosalpinx: This is a condition where fluid accumulates at the ends of the fallopian tubes. It can prevent the embryo from implanting in the uterus and hinder a successful pregnancy. Continuing IVF treatment without addressing hydrosalpinx may increase the risk of repeated failure.
Risk of Ectopic Pregnancy: Women with tubal issues have a higher risk of ectopic pregnancy (pregnancy outside the uterus). If the embryo implants outside the uterus, the pregnancy cannot proceed. Ectopic pregnancies can lead to repeated IVF failure.
3. Hormonal Imbalances: These can affect the reproductive process and impact the success rate of IVF treatment.

Insufficient Hormone Levels: Proper hormone levels support ovulation, ensure thickening of the endometrial lining, and help the embryo implant successfully in the uterus. Hormonal issues, such as luteal phase defect, can result in low hormone levels and lead to repeated IVF failure.
Thyroid Problems: Thyroid hormones have a significant impact on the reproductive system. If thyroid function is impaired, it may cause ovulation disorders, reduced endometrial thickness, and implantation failure. Thyroid issues can increase the risk of recurrent IVF failure.
4. Genetic Factors: Genetic factors play a crucial role in embryo development, implantation, and the progression of pregnancy.

Genetic Abnormalities: Embryos with genetic abnormalities may result in failed implantation or pregnancy loss. These abnormalities can occur in chromosome structures or due to gene mutations. In couples experiencing repeated IVF failures, the role of genetic abnormalities should be investigated.
Genetic Carrier Status: Genetic diseases carried by either partner may negatively affect embryo development and the pregnancy process. In such cases, embryos can be subjected to genetic testing to detect carrier status or genetic abnormalities.
Genetic Predisposition: In some couples, a genetic predisposition may hinder healthy embryo development and pregnancy progression. This may result in repeated IVF failure.

5. Immunological System: The immune system protects the body by responding to foreign substances. However, in some cases, imbalances or overreactions in the immune system can negatively affect the success of IVF treatment.

Autoimmune Diseases: Autoimmune diseases are conditions in which the immune system attacks the body's own tissues. These diseases can negatively affect the reproductive system and may lead to repeated IVF failure. For example, autoimmune disorders like antiphospholipid syndrome can cause blood clotting issues and implantation problems.
Inflammation and Implantation Disorders: Immunological problems can cause inflammation and tissue damage. This can affect the quality of the endometrium (the uterine lining) and negatively impact implantation success.

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

1. Genetic Tests

• Karyotype analysis: Examination of the chromosomal structure of both partners.
• Preimplantation Genetic Testing (PGT): Genetic screening of embryos before implantation.
• Carrier screening tests: Testing the couple for the possibility of carrying genetic disorders.

2. Hormonal Tests

• FSH (follicle-stimulating hormone) and LH (luteinizing hormone) levels: To assess ovulatory function.
• Estradiol (E2), progesterone, and prolactin levels: Analysis of hormonal balance.
• Thyroid hormones (TSH, T3, T4) test: To evaluate thyroid function.

3. Immune System-Related Tests

• Antibody screenings: To examine immune system responses during the implantation process.
• Antiphospholipid antibody test: To detect blood clotting and implantation problems.

4. Implantation and Uterine Evaluation

• Hysteroscopy: A procedure used to examine the inner surface of the uterus.
• Endometrial biyopsi: Endometrium dokusunun analizi için alınan örnekler.
  Uterin anormalliklerin değerlendirilmesi için ultrason veya MRI.

5. Embryo Quality and Development Assessments

• Embryo morphology assessment: Analysis of embryo structure and development (using an EmbryoScope).

Treatment Methods for IVF Failure

1. Preimplantation Genetic Testing (PGT): Selection of healthy embryos through genetic testing to increase the chances of implantation.

2. Embryo Selection and Transfer Techniques:

• Blastocyst transfer: Transferring embryos after developing them to the blastocyst stage.
• Hatching technique: Increasing implantation chances by softening or opening the embryo's shell.
• Embryo selection using morphological evaluation, such as with an EmbryoScope or artificial intelligence methods.

3. Endometrial Preparation:

• Using either the Natural Method or the Artificial Method based on the patient's clinical suitability
• Endometrial lining preparation
• Providing luteal phase support

4. Immune Modulation:

• Immunosuppressive drugs to balance the immune system through regulatory treatments

5. Thrombophilia Treatment:

• Use of low-dose aspirin and heparin for the treatment of thrombophilic conditions such as antiphospholipid syndrome

6. Tissue Compatibility and Immunological Treatments:

• Regulating the immune system through immunological treatments (e.g., intralipid therapy, immunoglobulin therapy)

7. Alternative Reproductive Methods

• Using donor eggs or donor embryos
• Surrogacy method

(Alternative reproductive methods are not practiced in Turkey; their recommendation is not legal. Personally, I would like to express that I do not find it ethical to suggest the use of another person’s egg or sperm to a couple.)

Why Does IVF Fail?

Advanced maternal age, low ovarian reserve, poor sperm quality, an unsuitable uterine environment, genetic problems, a history of recurrent miscarriage, and unhealthy lifestyle habits (such as smoking, obesity, alcohol, and drug use) are associated with failed IVF attempts.

What Should Be Done to Support Embryo Implantation in IVF?

The chances of implantation can be increased through optimal ovarian stimulation, embryo selection via preimplantation genetic diagnosis, blastocyst transfer, improvement of the uterine environment, supportive medications, and positive lifestyle changes.

What Should Be Done to Increase IVF Success Rates?

Regular exercise, healthy nutrition, and stress management increase the chances of success in IVF treatment.