IVF treatment is a hopeful journey for couples dreaming of having a child. However, sometimes, despite all expectations, the treatment may not yield a positive outcome, leading to the heartbreaking question: "Why does IVF fail?" This can be deeply distressing for couples, especially in cases of recurrent IVF failure. Understanding the reasons behind this situation and charting a new course is of paramount importance. At Ankara IVF Center, with our expert team, we support our couples through this challenging process with scientific and personalized approaches. In this article, we will delve into the possible reasons for this condition, also known as implantation failure, and the steps that can be taken.
Embryo-related causes
The quality and genetic structure of the embryo play a critical role in the success of IVF treatment. For a healthy pregnancy to begin, the embryo transferred to the uterus must be genetically normal and have high developmental potential. However, in some cases, embryo-related factors can lead to implantation failure.
- Embryo Quality: Embryos developed in the laboratory are morphologically (structurally) evaluated. Embryos with poor quality, slow development, or a high fragmentation rate have a lower chance of implantation. However, even an embryo that appears to be of good quality externally may have genetic problems.
- Genetic Abnormalities (Aneuploidy): Abnormalities in the number or structure of chromosomes in embryos can prevent the embryo from implanting in the uterus or, if it does implant, lead to early pregnancy loss. Advanced maternal age, in particular, can increase the risk of such genetic problems. For such situations, Genetic Diagnosis (PGT) methods allow for the genetic evaluation of the embryo before it is transferred to the uterus. PGT can increase the chance of selecting and transferring healthy embryos and help reduce the risk of recurrent IVF failure.
- Embryonic Development Arrest: The arrest of embryonic development at a certain stage or the inability to reach the blastocyst stage in a healthy manner is also a significant factor that negatively affects the chance of implantation.
The quality and genetic structure of the embryo are among the first and most crucial steps in IVF treatment. Therefore, embryo development and selection processes must be meticulously carried out by experienced embryologists.
Uterine-related causes
No matter how good the embryo quality, for a healthy pregnancy to occur, the uterine environment where the embryo will implant must also be suitable. An unsuitable intrauterine environment, meaning uterine-related factors, is one of the significant causes of implantation failure.
Structural Abnormalities within the Uterus
- Polyps and Fibroids: Polyps located within the uterus or fibroids developing in the uterine wall (especially submucosal fibroids growing into the uterine cavity) can physically obstruct embryo implantation or disrupt the structure of the uterine lining (endometrium), reducing its implantation potential.
- Intrauterine Adhesions (Asherman's Syndrome): Adhesions can form within the uterus as a result of previous curettages, infections, or surgical interventions. These adhesions narrow the uterine cavity or disrupt the normal function of the endometrium, making embryo implantation difficult.
- Congenital Uterine Anomalies: Some women may have congenital structural abnormalities of the uterus (e.g., septum, bicornuate uterus). These anomalies affect the shape and size of the uterine cavity, negatively impacting embryo implantation and development.
Endometrial Receptivity Issues
Endometrial receptivity is the ability of the uterine lining (endometrium) to accept the embryo. For the embryo to implant, the endometrium must have a certain thickness and structure, and also be ready to accept the embryo at the correct timing.
- Endometrial Thickness and Structure: Current evidence indicates that an endometrial thickness of 7 mm or more is considered sufficient for embryo implantation in most patients; 8 mm is a commonly targeted practical value rather than an absolute cut-off. A very thin or irregularly structured endometrium reduces the chance of embryo implantation.
- Chronic Endometritis: Chronic inflammation of the uterine lining, although often asymptomatic, can cause implantation failure. This condition can be diagnosed with special tests and corrected with appropriate antibiotic treatment.
- "Window of Implantation" Timing: Each woman's endometrium has a specific time frame when it is most receptive to accepting an embryo. This timing can vary from person to person. In some cases, failure may occur because the embryo transfer falls outside this "window of implantation."
For the diagnosis and treatment of these uterine-related problems, endoscopic surgical methods such as Laparoscopy & Hysteroscopy play an important role. Hysteroscopy allows direct visualization of the uterine cavity, enabling the treatment of polyps, fibroids, or adhesions. Laparoscopy is used for the diagnosis and treatment of problems outside the uterus (such as endometriosis). Such interventions can make the uterine environment more favorable for embryo implantation.
Immunological and hematological factors
The body's immune system and blood clotting mechanism play a complex role in the initiation and maintenance of pregnancy. In some cases, imbalances in these systems can lead to recurrent IVF failure and implantation failure.
Immunological Factors
Pregnancy is a unique immunological event that requires the mother's body to accept the embryo, which is genetically partially foreign. Problems can arise when this delicate balance is disrupted:
- Natural Killer (NK) Cells: Uterine NK cells are important immune cells that normally help with embryo implantation. However, in some women, excessive activity or an increased number of these cells can cause them to perceive the embryo as a threat and reject it.
- Antiphospholipid Antibody Syndrome (APS): In this autoimmune disease, the body produces antibodies against its own cells. These antibodies can affect placental development by disrupting blood flow, preventing embryo implantation, or causing early pregnancy losses.
- HLA Incompatibility: Certain genetic incompatibilities between the mother and father can increase the risk of the embryo being rejected by the mother.
The diagnosis of these immunological factors requires specific blood tests and advanced investigations. Treatments may include approaches aimed at balancing the immune system, but a personalized evaluation for each patient is essential.
Hematological Factors (Blood Clotting Disorders)
Disorders in the blood clotting system can lead to micro-clots in the placenta, negatively affecting embryo nourishment and implantation:
- Thrombophilia: Certain genetic or acquired clotting disorders (e.g., Factor V Leiden mutation, Prothrombin gene mutation) cause blood to clot more easily than normal. This can lead to clot formation in the small blood vessels within the uterus, disrupting embryo implantation and development.
- Hyperhomocysteinemia: High homocysteine levels can also increase the risk of clotting and negatively affect pregnancy outcomes.
Tests for blood clotting factors are performed for the diagnosis of such conditions. Treatment may involve methods such as blood-thinning medications or folic acid supplementation. However, the application of such treatments must be under the detailed evaluation and supervision of a specialist physician.
Advanced investigations
For couples experiencing recurrent IVF failure, conducting detailed investigations beyond standard tests can help find the answer to the question "why does IVF fail?". At Ankara IVF Center, we offer a comprehensive evaluation in this process:
- Karyotype Analysis: Examination of the chromosome structure of both the mother and father can reveal potential problems such as genetic imbalances or translocations. These conditions can increase the risk of genetic abnormalities in the embryo.
- ERA (Endometrial Receptivity Analysis) Test: The optimal time window for the uterine lining (endometrium) to accept the embryo, known as the "window of implantation," can vary from person to person. The ERA test can help determine this window individually, ensuring embryo transfer is performed at the correct time.
- ALICE (Analysis of Infectious Chronic Endometritis) and EMMA (Endometrial Microbiome Metagenomic Analysis) Tests: Chronic endometritis and imbalances in the uterine microbiome can contribute to implantation failure. These tests evaluate intrauterine infections and the state of the bacterial flora, helping to determine appropriate treatment strategies.
- Hysteroscopy and Laparoscopy: Surgical methods such as Laparoscopy & Hysteroscopy are the gold standard for the diagnosis and treatment of structural abnormalities (polyps, fibroids, adhesions, endometriosis) within and around the uterus.
- Thrombophilia Panel and Immunological Tests: Detailed blood tests are performed to identify blood clotting disorders and immune system-related problems. These tests allow for the identification of potential risk factors and the development of personalized treatment approaches.
- Sperm DNA Fragmentation Tests: Male factor issues can also play a role in implantation failure. Sperm DNA damage can negatively affect embryo quality. These tests evaluate the genetic integrity of sperm.
These advanced investigations are applied selectively according to each patient's condition, and a personalized treatment plan is created based on the findings. Prof. Dr. Mehmet Çınar and his team guide couples through this complex process using the latest scientific approaches.
Strategy for a new attempt
Deciding on a new attempt after recurrent IVF failure is a challenging process that brings both hope and anxiety. However, with the right strategies and a comprehensive evaluation, it is possible to increase the chances of success. At Ankara IVF Center, we determine a personalized roadmap for each couple, considering their unique situation.
Comprehensive Evaluation and Personalized Planning
- Analysis of Previous Experiences: A detailed analysis of all previous IVF attempts is performed. The stage at which problems occurred (egg development, fertilization, embryo development, implantation), the protocols used, and the results obtained are meticulously examined.
- Review of All Factors: All findings from embryo-related, uterine-related, immunological, and hematological factors, as well as advanced investigations, are brought together. This holistic approach allows us to find clearer answers to the question of why IVF fails.
- Restructuring the Treatment Protocol: Based on the data obtained, all steps, such as the egg retrieval protocol, medications used, embryo development strategies, and embryo transfer timing, are re-evaluated and optimized specifically for the individual. For example, for patients with poor ovarian reserve, different stimulation protocols, for those with embryo quality issues Genetic Diagnosis (PGT), and for those with intrauterine problems Hysteroscopy, may be planned as additional treatments.
Hopeful and Realistic Approach
Every unsuccessful attempt provides valuable information for the next step. The important thing is to interpret this information correctly and shape the treatment strategy accordingly. Prof. Dr. Mehmet Çınar helps couples maintain their hope by conveying scientific facts and providing psychological support throughout this process. It should be remembered that many couples experiencing recurrent IVF failure can eventually achieve pregnancy with the right diagnosis and treatment approaches. IVF treatment is a process that requires patience and determination, and every attempt is an opportunity for a new beginning.
To learn more about Prof. Dr. Mehmet Çınar's expertise and experience, please visit Prof. Dr. Mehmet Çınar's profile page.
As Ankara IVF Center, we continue to support couples seeking answers to "why IVF fails" and struggling with recurrent IVF failure, using the most current scientific methods. You are not alone on this challenging journey. To arrange a detailed evaluation and create a personalized roadmap for you, you can schedule a free initial consultation with our expert team and share your questions and concerns. Remember, every new attempt is an opportunity to get one step closer to your dreams.