When a couple attempts to get pregnant but does not manage to do so, particularly when gestation is not achieved following in vitro fertilisation (IVF) treatment with the couple’s own ova or with donated ova, it is essential that they avoid wasting any time and put themselves in the very best of hands because the problem is often due to implantation failure (although the embryo would not appear to have an anomaly of any kind, it does not implant in the uterus).
Years of experience with this matter naturally inspired Instituto Bernabeu, a leading entity in the field of avant-garde assisted reproduction, into setting up an Implantation Failure and Recurrent Pregnancy Loss Unit in 2009. The unit focuses specifically on these issues.
The solutions patients are given are always personalised to match their own particular needs. The unit feeds off a combined knowledge obtained through studying and treating hundreds of couples with this pathology during day-to-day work at the clinic, and intense scientific work that focuses on increasing knowledge of the nesting process in the third patient: the embryo and the response of the mother’s endometrium to the immunological invasion involved in accepting another being that is, furthermore, multiplying cells at a ferocious rate.
The unit is constantly making scientific progress and this is reinforced by publications in leading journals and acceptance for presentations in medical committees at leading international congresses.
Implantation failure studies should always begin with an analysis of the couple’s clinical data, taking into account family background and evaluating environmental exposure to toxins, lifestyle and so on. A high-resolution 3D ultrasound scan with powerful software is also essential in order to detect conditions that have a negative impact on nesting. For example, adenomyosis, a condition in the uterine cavity that generates embryo implantation failure and that has so far been difficult to diagnose.
After this, the team can assess a number of specific studies aimed at getting an in-depth understanding of the semen, the uterus, and the immune system. For example, vitamin D, phenylalanine hydroxylase (Phe) levels, thrombophilia analyses, sonohysterography and a possible biopsy on the endometrium in order to get an understanding of uterine receptivity, the genetic profile of associated chromosomes, possible DNA fragmentation, etc.
Once each couple’s individual profile has been examined, the multi-disciplinary team of specialists including gynaecologists, endocrinologists, geneticists and pharmacists designs a course of treatment that is adapted to the couple’s specific needs.
Another key factor in resolving implantation failure and premature pregnancy loss is a metabolic and genetic study of the embryo.
When using traditional means of analysis, an embryo can appear to be entirely morphologically normal, but a genetic study of the embryo is required in this group of patients because it provides much more concrete information, as well as avoiding the transfer of embryos which, despite looking perfect, will not lead to a successful pregnancy.
This analysis avoids the stress associated with unnecessary beta pregnancy tests that later end in embryo arrest. It also helps to get to the point of a successful pregnancy sooner because, as a result of having an understanding of chromosomal make-up thanks to the CCS-NGS technique, only embryos that are genetically normal are transferred.
In order to carry out an appropriate analysis of the embryo, as well as embryologists who are specialists in biopsies that cause no harm whatsoever to the surface of the blastocyst, Instituto Bernabeu has groundbreaking in-house genetics laboratories. This ensures speed and efficiency in diagnoses, as well as correct traceability in sample management.
Another important area of progress is the uterine contractility study used to optimise the best time and place in the endometrium for facilitating embryo nesting when the time has come to transfer to the mother.
Whilst this group of patients remains a complex one because there is still a lot to be learnt about the mystery of embryo implantation, progress at Instituto Bernabeu is opening up a door of hope that has made it possible to form thousands of new families.