Implantation Failure and Miscarriage

1
Implantation Failureand Miscarriage

• Ankur Fertility and Womens Clinic

www.drsuparnabanerjee.com
2
Implantation Failure Miscarriage

• In the majority of cases when an IVF treatment
  cycle fails or when someone suffers a miscarriage
  the cause is embryo-related.
• However, should couples fail to achieve success
  repeatedly with good quality embryos (recurrent
  implantation failure - RIF) or suffer from
  recurrent miscarriage (RM) further investigation
  should be considered to minimize the physical and
  emotional burden and ensure there are no
  potentially treatable causes.

3
Implantation Failure Miscarriage

• In those with RIF, the exact time when these
  tests will be recommended will depend on factors
  such as age, embryo quality and number of failed
  cycles.
• Although, some advocate testing of those with
  recurrent miscarriage only after 3 miscarriages,
  studies have suggested that as many potentially
  treatable causes are identified when couples are
  screened after 2. Therefore, again depending on
  other factors such as age, at the Ankur Fertility
  Clinic we will often recommend screening at this
  point.

4
Maternal Tests / Treatments

• Thrombophilia (Clotting) Screen

• We will aim to exclude a number of genetic or
  acquired disorders that increase the risk of
  small clots in the blood than can cause
  pregnancies to fail. These are often amenable to
  simple treatment with Aspirin or Heparin to thin
  the blood.

5
Maternal Tests / Treatments

• Reproductive Immunology

• Although a controversial area, some evidence
  suggests that an overactive immune response and
  in particular an increase in the numbers or
  toxicity of natural killer cells may impact on
  implantation and pregnancy outcome.

6
Maternal Tests / Treatments

• Hormonal Screening

• Although a controversial area, some evidence
  suggests that an overactive Subtle hormonal
  disorders such as even a thyroid function result
  normal for "general" health but not optimal to
  cope with the strains of early pregnancy should
  be tested for and treated if appropriate.
  Similarly progesterone is vital to support the
  endometrium (womb lining) but if rises too early
  can induce the lining to mature too early and not
  be receptive to a good quality embryo.
  Progesterone levels should also be checked during
  stimulation to ensure this does not occur and if
  significantly raised embryo freezing may be
  considered.

7
Maternal Tests / Treatments

• Anatomical Screening

• A more detailed assessment of the
  endometrium/womb may be recommended. Depending on
  the clinical history this maybe performed in a
  number of ways
• Hysterosalpingogram Dye may be passed into the
  womb to exclude a structural abnormality in the
  womb or collection of fluid in the tubes
  (hydrosalpinx) that can impact on outcome.
• 3D Ultrasound To exclude a structural
  abnormality by high definition 3D scanning.
• Hysteroscopy More direct visualization of the
  womb lining by passing a small telescope into the
  womb often under general anaesthetic.

8
Maternal Tests / Treatments

• Endometrial Scratch

• Recent studies have suggested that stimulation of
  the womb lining prior to treatment may improve
  outcome in those with previous cycle failure.

9
Maternal Tests / Treatments

• Endometrial Receptivity Array (ERA)

• Recent studies have suggested that assessing
  certain genes within the lining of the womb may
  help determine the correct time for embryos to be
  transferred.

10
Maternal Tests / Treatments

• Post-Transfer

• There are many myths surrounding the period
  post-transfer but in essence it can be a
  stressful time waiting for the test day so we
  encourage women to resume normal activities. The
  pregnancy test will be two weeks after egg
  collection. You will be taking progesterone
  supplementation in this time to support the
  lining of the uterus and in the event of a
  positive pregnancy test, progesterone
  supplementation is continued until week 12 of the
  pregnancy.

11
Maternal Tests / Treatments

• Sperm DNA

• Evidence has suggested that raised levels of
  sperm DNA damage may be associated with failed
  IVF (with ICSI/IMSI improving outcome) and
  miscarriage.

12
Maternal Tests / Treatments

• IMSI

• In those couples with recurrent failed ICSI
  cycles, studies have suggested that the use of
  IMSI, allowing us to select the sperm using
  higher magnification microscopes may improve
  outcome.

13
Genetic, Embryology Tests / Treatments

• Karyotype

• A simple blood test can exclude that either
  partner has a subtle genetic variation that may
  explain either RIF or RM.

14
Genetic, Embryology Tests / Treatments

• Embryo Selection Techniques

• Although they may not alter outcome as many
  couples have only few developed embryos, these
  methods may give vital information as to the
  potential causes of cycle failure and minimise
  the risk of further miscarriage.

15
Embryoscope to monitor embryo development with
continue time-lapse video monitoring.
16
Contact Us!

• 23A/661A , New Alipore, Block O
• Kolkata, West Bengal, 700053
• Write Us ankurfertilityc_at_gmail.com
• Call Us 91 90513 71257 / 91 6290 627 536

Follow us on social media
linkedin.com/company/ankur-fertility-clinic youtu
be.com/channel/UCuk8tf-KI3bwNRTweISe-qA twitter.co
m/ankurfertility instagram.com/ankurfertilityclini
c
17
THANK YOU