Onm-8: Recurrent Implantation Failure in IVF/ICSI Cycle

The success of assisted reproduction, although gradually increasing over the years, is still less than satisfactory. Many couples have benefited from this treatment; many have also been left frustrated following multiple failed attempts (Bulent Urman et al. 2005). Repeated implantation failure (RIF), defined as three or more failed IVF attempts or failure of IVF after cumula- Abstracts of the 5th Royan Nursing and Midwifery Symposium International Journal of Fertility & Sterility (IJFS), Vol 4, Suppl 1, Summer 2010 88 tivetransfer of more than 10 good quality embryos, represents one of the major challenges to assisted reproduction practice (Christophe Blockeel et al. 2008). One of the prime factors implicated in the failure of assisted conception treatment is the inability of the embryo to implant into the endometrium. Several areas have been explored in attempts to improve implantation, including: the embryo transfer technique (Anderson et al. 2002; Pope et al. 2004); endometrial receptivity (Stern et al. 2003; Stephenson and Fluker 2000); the presence of hydrosalpinges and uterine fibroids (Barmat et al. 1999; Camus et al. 1999; Strandell et al. 1999; Hart et al. 2001; Check et al. 2002) and implantation potential of the embryo itself (Levitas et al. 2004; Caglar et al. 2005). It is evident that the aetiology underlying recurrent implantation failure is complex that cannot be attributed to a single abnormality. In couples who repeatedly give rise to bad quality embryos, Preimplantation genetic diagnosis (PGD) may be undertaken to assess the ploidy status of individual embryos. The genetic analysis is performed on one or two blastomeres, by fluorescent in situ hybridization (FISH) for cytogenetic diagnosis, or polymerase chain reaction (PCR) for molecular diagnosis. Genetic analysis of the first or second polar body can be used to study maternal genetic contribution (Claire Basille et al. 2009). Such couples should be discouraged from undergoing further treatments if all embryos are aneuploid. When euploid embryos are found among the cohort, further treatment attempts may eventually be rewarded with a conception.In couples who fail to conceive despite the transfer of good quality embryos, other factors that may impede implantation should be sought and corrected when identified. Normality of the uterine cavity should be confirmed with office hysteroscopy (Urman et al. 2005). Faulty embryo transfer technique should be rectified. Intratubal embryo transfer may be considered if the patient underwent previous difficult transcervical embryo Assisted hatching and blastocyst transfer can also be considered in patients with recurrent implantation failure. Screening for APA (Antiphospholipid antibody) is not routinely carried out, nor are empirical treatments such as aspirin, heparin, or leukocyte isoimmunization. co-cultures, these should be advised with caution. In couples with recurrent implantation failure with the transfer of good quality embryos, preimplantation genetic screening does not increase the implantation rates after IVF−intracytoplasmic sperm injection (Christophe Blockeel et al., 2008)