Thursday, March 28, 2013

IVF-FAQs - If I have repeated implantation failure, does this mean my uterus is defective ? Should I opt for surrogacy ?

When women go through a couple of failed IVF cycles, the first doubt that comes to their mind is – is my uterus defective ? Is it rejecting my beautiful embryos ?  They start believing that implantation is not occurring because their uterus is defective . Their doubt appears very logical , because they can see that their embryos are growing well and are of Grade A quality .  When the doctor says  - Your embryos look beautiful and you have a very good chance of getting pregnant ( something most IVF doctor will say at the time of transfer, when they create good quality embryos in the lab), they start thinking that they are definitely going to get pregnant. When these beautiful embryos fail to implant, they start doubting the ability of their uterus to sustain a pregnancy. It is true that the uterus plays an important role in implantation , but not as much as the embryo does. When you develop a good endometrial lining and if your uterus does not have any gross abnormalities , it normally functions very well, no matter how old you are . However, even Grade A blastocysts which look perfect under the microscope can carry genetic defects which prevent them from implanting successfully.  This means that when both the embryos and the uterus appear perfect, it’s statistically much more likely that the embryo will be defective, as compared to the uterus. Let’s think about this logically. If all perfect embryos were to implant , then why does only one out of the 2 or 3 Grade A embryos which are transferred into a receptive uterus implant ? Why don’t all of them implant and give rise to multiple pregnancies ? If it was endometrial receptivity which played the major rate limiting factor in implantation , then all the Grade A embryos that are transferred to a women who gets pregnant in a particular cycle would have implanted ! The fact that only some of the Grade A embryos implant even in a successful cycle shows that it is the competency of the embryo which plays a major role in achieving implantation – not the uterus. 

Even when you go through multiple implantation failures, there is a greater possibility that it is your embryos that are genetically defective , rather than your uterus. This is especially true if you are a women of advanced maternal age or have poor ovarian reserve. This is why older women get pregnant so easily with donor eggs, while they fail to achieve a pregnancy with their own eggs ! So if your uterine  cavity is normal , and if it develops a good endometrial layer, it is wise not to opt for surrogacy. Surrogacy is a good solution only for the very small minority of women whose uterus is damaged or absent. Unfortunately, the innocent uterus is blamed all the time when a couple faces infertility . “She is barren” on “In her uterus nothing grows, not even worms” - these are some of the hurting barbs directed against infertile women - and these break her  confidence in the ability of her uterus to carry a baby !

Can’t we tackle this problem by checking the embryos before transferring them ? Unfortunately, there are no fool proof ways of selecting embryos which are genetically normal as of now; but recent scientific discoveries like “comprehensive chromosome screening (CCS)” appear promising.

Read more at : http://www.drmalpani.com/solution_for_repeated_implantation_failure.htm

This is an excerpt from our forthcoming, book, The Expert Patient's Guide to IVF. This being authored by our expert patient, Manju and me.

 You can email Manju at manjupadmasekar@yahoo.com

Her blog is at www.myselfishgenes.blogspot.com

2 comments:

  1. Anonymous9:21 AM

    This article gives me hope after just getting a negative on my 3rd embryo transfer. Never had implantation and was really starting to blame my uterus. My donor was very prove and we had beautiful embryos. I'm still not convinced it's the embryos. I've seen an RI and learned we have DQA/HLA matches and some other immune issues, like elevated NK cells. How do you feel these come into play with implantation failure? What about blood flow to the uterus as a cause? Thanks so much for the article though. We have one embryo left and it gives me hope.

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  2. I feel NK testing is a waste of time. Lots of fertile women have high NK cells ( and have enough sense not to go to a doctor to get their NK cell levels tested !)

    You can read about this at www.drmalpani.com/wasteful-infertility-tests.htm

    Can you send me photos of your embryos please ?

    You can see what embryos should look like at www.drmalpani.com/embryos.htm


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