Failed IVF Treatment in Maldives: Yaami

Repeated IVF failure is a very disappointing condition for couple as well as the fertility specialist. Repeated IVF failure is a broader term which includes Recurrent Implantation Failure ( RIF )along with other reasons of failure of IVF like cancelled treatment in cases of poor ovarian response during stimulation, advanced age, immature oocytes, no oocyte available, no sperms available, poor quality embryos etc.

Recurrent Implantation Failure (RIF) :

Recurrent implantation failure (RIF) is failure to conceive after 2-3 embryo transfers attempts.
RIF can happen either due to issues in embryo quality where an abnormal embryo fails to implant in receptive (ready for implantation) endometrium or due to endometrial receptivity issues where a normal embryo fails to implant due to non-receptivity of endometrium.
The treatment of repeated IVF failure & RIF is tailored towards identifying & correcting those issues.

Embryo quality issues can be due to:

Advanced maternal age- high risk of chromosomal abnormality in oocytes
Poor oocyte(egg) quality
Parental chromosomal abnormalities
Poor quality sperm
High sperm DFI (DNA Fragmentation Index)
Hardeningof Zona pellucida (outer covering of the egg)
Suboptimal embryo culture conditions
Smoking

Endometrial receptivity issues can be due to:

Defect in anatomy (size & shape) of uterus : Polyp , fibroid, adenomyosis, thin endometrium (lining of uterus), adhesions, septum.
Endometritis (infection of endometrium)
Defect in function of endometrium
Immunological factors causing rejection of embryo
Thrombophilia (blood clotting disorders)
Presence of hydrosalpinx (liquid filled fallopian tubes)

Treatment is based on correction of above factors like:

Improvement in oocyte & sperm quality with life style changes & medications.
Optimal ovarian stimulation protocol
Optimal embryo culture conditions
Blastocyst culture
Selection of normal embryo having normal chromosomes with Preimplantation genetic test for aneuploidy (PGT-A)
Surgical correction of uterine defects
Assessment of endometrial receptivity with Endometrial receptivity array (ERA)
Improving endometrial receptivity with G-CSF /PRP intrauterine infusion.
Use of Intralipid to help in implantation.
Immunotherapy

Embryo quality issues can be due to:

Advanced maternal age- high risk of chromosomal abnormality in oocytes
Poor oocyte( egg) quality
Parental chromosomal abnormalities
Poor quality sperm
High sperm DFI (DNA Fragmentation Index)
Zona pellucida hardening (its covering of oocyte)
Suboptimal embryo culture conditions
Smoking

Endometrial receptivity issues can be due to:

Defect in anatomy (size & shape) of uterus : Polyp , fibroid, adenomyosis, thin endometrium (lining of uterus), adhesions, septum .
Endometritis (infection of endometrium)
Defect in function of endometrium
Immunological factors causing rejection of embryo
Thrombophilia (blood clotting disorders)
Presence of hydrosalpinx (liquid filled fallopian tubes)

Treatment is based on correction of above factors like:

- - Improvement in oocyte & sperm quality with life style changes & mediation
  - Optimal stimulation protocol
  - Optimal embryo culture conditions
  - Blastocyst culture
  - Selection of normal embryo having normal chromosomes with PGT-A
  - Surgical correction of uterine defects
  - Assessment of endometrial receptivity with ERA
  - Improving endometrial receptivity with G-CSF /PRP intrauterine infusion .
  - Use of Intralipid .