Unfortunately IVF treatment is not always successful, it works more successfully in younger women, and far less in women over 35- 40 years of age. After a failed cycle one feels grief, anger and frustration. It is normal to feel so, but one should not blame self or the partner for this predicament. There can be several reasons and chances are some of these reasons can be out of your or doctors control. A talk with IVF consultant or doctor can help cool down some of the feelings and help to decide what steps to take next.

Repeated IVF failure can be defined when 3-4 good looking embryos with eight cell stage fail to result in a pregnancy in at least  three IVF attempts.

It can be divided in to two:

• Repeated Implantation failure
• Repeated Pregnancy failure

Repeated Implantation Failure (RIF)

Repeated implantation failure is the failure of the embryo to implant in the uterus wall following IVF treatment. This happens on day 6-7 days after embryo transfer. This resultant exchange of biochemical information between the embryo and the uterine lining culminates in implantation. The enzyme released by the embryo digests the endometrial lining to embed the embryo in the uterus establishing connectivity with maternal circulation. A successful implantation can be determined by using an ultrasound to view the sac in which the baby grows, inside the uterus.

Repeated implantation failure and recurrent IVF failure are two different things. Recurrent IVF failure is a much more broader term and includes all repeated failures to get pregnant by IVF. Repeated implantation failure includes repeated implantation failure.

An unsuccessful implantation can be due to either problems with the mother or with the embryo. It is essential that the mother and embryo are able to communicate with each other during all stages of pregnancy, and an absence of this communication can lead to an unsuccessful implantation and a further unsuccessful pregnancy.

Repeated Pregnancy Failure

The term repeated pregnancy failure is a much broader term as it includes other causes than only implantation failure, such as genetic causes as well immune reactions to the implanted embryo.

What are the Causes of Repeated IVF Failure

The causes of repeated IVF failure can be divided in to two groups.

• Embryonic causes
• Maternal causes

The Embryonic Causes Can Be

1. Genetic causes or genetic abnormalities leading to malformation of embryos.
2. Age of the eggs or the age of the women.
3. Other intrinsic factors that impair the ability of embryo to develop in uterus to hatch and implant such as zona pellucida.

Sometimes embryos from low quality eggs are transferred on day 5-6 instead of day 3. This gives the doctor to select only healthy embryos for transfer. Embryos having abnormalities fail to implant resulting in failed IVF cycles.

Age of eggs:- The age of the women plays an important role in the success of IVF outcome. As the women age the quality and quantity of eggs goes down. This greatly affects the chances of pregnancy with or without IVF. At Delhi IVF the success rate for women under 37 is 39% and it is less than 17% over 38 years. On an average only 25% embryos used in IVF cycles result in live birth. Older women have better chances with donor (younger) eggs.

Poor Responders:-  In women over 37 years, it is difficult have enough or good quality eggs. It is for this reason the chances of IVF failure are high. Some of the known causes are

1. Chromosomal abnormalities- Since a women is bestowed with all the eggs she will need, to last from puberty to menopause, at the time of birth. The eggs suffer from large number of genetic changes during this time. Often the cause miscarriage and implantation failure during IVF for women over 30 increases due to chromosomal

The symptoms:-

• Sensitive breasts, Nausea, Fatigue, Cramps, Light spotting.

There are various biological reasons why these two situations could be related. Various investigations which can help us to overcome these impediments are:

Investigations and Treatments for Repeated Implantation Failure

There are several options where for patients with recurrent implantation failures. we can discuss these options with the patient in a follow up appointment. In devising treatment programs, there are investigations we can carry out before treatment commences, which help us to tailor your treatment closely to your needs.

There are some other options and tests which can help the doctor to modify the treatment protocol or some other strategies which can help the patient complete the family in case of implantation failure or miscarriage.