Today, in vitro fertilization (IVF) is a must for many couples with fertility problems. Since Amandine in France in 1982, the technique has continued to develop, offering patients more effective and safer therapeutic solutions. Nevertheless, 27% of couples who fail on their first attempt abandon their IVF project before trying a second time.
A medical feat but also a complex emotional journey, IVF is now reimbursed in France for up to 4 attempts. It is therefore essential to analyze failures before the 4th and final attempt, in order to find appropriate medical solutions. While the majority of implantation failures are still difficult to explain, new perspectives are opening up thanks to personalized care to optimize live-birth rates.
Analysis of possible causes of repeated embryo implantation failure
After a cycle of ovarian stimulation, the mother’s oocytes are harvested for laboratory fertilization. The embryo(s) obtained are then transferred in the patient’s uterine cavity. This crucial stage is difficult to control and supervise from a medical point of view, and is the most critical and difficult stage in the process. It’s the black box.
Unfortunately, a woman may experience repeated IVF failures for a variety of reasons.
1. Embryo quality factors
Embryo morphological evalutation to assess (and optimized) embryo quality is essential to maximize the chances of successful implantation.
The first few days of cell development must go smoothly for the embryo to reach the blastocyst stage.These embryos must have undergone optimal cell division and present regular cell sizes and shapes. Genetic alterations can also cause implantation to fail, but are not visible.
2. Uterine and endometrial problems
If the transferred embryo ticks all the quality boxes before implantation, there is also the question of its reception in the maternal uterus. Abnormalities of the uterus or endometrium, for example, can impact the implantation window and reduce the chances of success.
Pathologies such as chronic inflammation, a thin endometrium, or the presence of polyps or fibroids can also contribute to the quality and reduced receptivity of the endometrium, and thus to the failure of embryo implantation.
3. Immunological factors
Immunological factors have long been overlooked by research, but we now know that they play a major role in implantation failures and recurrent miscarriages. Immune activation may be disrupted, requiring therapeutic adjustment to facilitate implantation.
4. Influence of lifestyle
The couple’s lifestyle and immediate environment are important factors in optimizing the chances of IVF success. If both partners are in good physical and mental health, they have every chance of success.
But that’s not enough! As Lou Exposito, a clinical psychologist specializing in ART, rightly puts it: “There’s a kind of injunction to positive thinking and magical thinking, which gives us an illusion of control: ‘If it didn’t work this time, it’s because I didn’t believe in it enough (or I was too stressed, not positive enough, etc.), so it’s up to me to do better next time’. What guilt this kind of thinking generates! We negotiate with this infantile remnant of magical thinking, but it’s false: if a pregnancy is going to hold, it will hold and no thought influences it.”
Personalized care to optimize embryo implantation success
In order to better understand the causes of IVF failure, endometrial immune profiling is an avenue worth exploring after 2 failures. By analyzing several biomarkers in endometrial mRNA, the test designed by MatriceLab can identify some local immune deregulations and suggest personalized therapeutic options. The objective is to create the best local environment suitable for embryo implantation.
Thanks to this new understanding of endometrial immune mechanisms, each patient can benefit from personalized therapeutic recommendations with specific gestures or treatments to be taken before, during and after the next IVF attempt.
“After a long, hard journey marked by 3 miscarriages (with 3 curettages and 2 hysteroscopies) and an ART with no results, I was able to take the MatriceLab test, which finally gave me some answers. And it changes everything to know and understand!
I became pregnant naturally some time later and, thanks to the protocol put in place, this pregnancy was the first to hold. Baby’s here now.
MatriceLab and the immune profile were a decisive turning point for me in this journey strewn with pitfalls and unanswered questions.”
Mathilde, now a mother.
The ART process, and IVF in particular, requires total commitment on the part of the patient, the couple and the entire medical team. Technological advances have also enabled us to identify immune factors that may explain, in part, repeated failures during the embryo transfer and implantation phase. This new diagnostic option in the reproductive physician’s toolbox complements many existing techniques and methods for assessing the quality of transferred embryos.
Today, it seems essential to use these techniques to find new answers to these physically and mentally demanding journeys. New solutions have been scientifically validated for many years to help you realize your parenthood project.