Huntington Reproductive Center - Blogs

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Dr. Michael Feinman Recommends Tests to Identify Cause of IVF Implantation Failure

Recurrent IVF failure is a real challenge for patients and their doctors. However, there are several tests that can help explain the nature of embryo implantation failure and lead to a successful pregnancy. I recommend the following tests be considered after two failed IVF cycles:  

Uterine Evaluation/Hysterosalpingogram (HSG)
The evaluation of the uterus clearly should be done before the first IVF cycle, and the HSG is the only test that adequately looks at the uterus and the fallopian tubes. A hydrosalpinx (blocked fallopian tube filled with fluid) reduces implantation by 50 percent, so you do need to know the tubal status even when doing IVF.

Sperm DNA Fragmentation Test
The DNA fragmentation assay looks at the integrity of DNA in the sperm.  If the assay is abnormally high (a high level of DNA fragmentation), it will result in lower implantation rates -- as well as lower fertilization rates and higher miscarriage rates. Men with normal semen analysis results can have abnormal DNA results.

Endometrial Biopsy Test for Implantation Markers
Since the 1990s, there have been a series of endometrial biopsy tests that look at implantation markers to determine if the lining of the uterus (endometrium) is receptive to implantation. The newest generation is the Endometrial Receptivity Assay (ERA) biopsy which tests to see if the endometrial “implantation window” is open on the correct day of the cycle. If  not, you can freeze the embryos and transfer them in a protocol that adjusts the number of days of progesterone given prior to the transfer.

Preimplantation Genetic Diagnosis (PGD)
Because the vast majority of embryos are abnormal, PGD is helpful in addressing the cause of implantation failure. With PGD, embryos are biopsied to determine whether they are chromosomally normal. Only normal embryos are transferred back into the uterus. For women under age 40, PGD is a more logical approach than multiple embryo transfer.

Immunologic Tests
The theory behind these tests, which are considered controversial, is that the immune system causes implantation failure. The tests may have appropriate value if everything else has been done—include PGD—and a patient is still not getting pregnant with good quality embryos. I tend not to do immunological testing before a woman’s first IVF cycle because it sets up the potential for over-treatment. When appropriate, I do offer a limited battery of tests to address this possible problem.

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