“Recurrent implantation failure has been the “black box” of reproduction,” says reproductive endocrinologist Dr. John Couvaras. The fact that 88 percent of IVF cycles would progress to embryo transfer but result in a positive pregnancy rate no higher than 50 percent, and an even lower live birth rate, has stymied many clinicians for years, and intrigued them to look for answers, Couvaras adds.
There are a number of symptoms that indicate an embryo has implanted: nipple sensitivity, heightened the sense of smell, unusual hunger, a uterus that feels heavy and crampy, slight discharge and increasing sleepiness. Within five days, if that implantation has failed, symptoms cease and the subsequent period gets markedly harder.
“Many patients say, ‘Ever since I’ve been trying to get pregnant I’ve developed this horrible dysmenorrhea.’ That’s not endometriosis as most people would argue; that’s people failing to implant and having many miscarriages,” Couvaras says. “When I hear this pattern, and I keep hearing it over and over, that suggests the person is not implanting, not because there’s a genetically abnormal embryo, but due to an inflammatory event. There’s something wrong with how the uterine environment is talking to the embryo. And because of that embryo-endometrial interaction, you or we can make the best embryos in the world and [IVF] is still not going to work.”
Couvaras says that for the last 12 years at his fertility practice, IVF Phoenix, he has been addressing inflammation and reproduction from the premise that low-grade infections generate markers of inflammation, and inflammation interferes with implantation.
He admits that there is not a quick solution for patients or a simple protocol for treating it, as inflammation is not a static concept. However, studies have shown that various treatments have proven successful in addressing implantation failure due to inflammation.
So what’s the takeaway? If you’ve had IVF failure, pay attention to whether you have or are having those early signs of implantation and subsequent implantation failure. It’s important to address those issues before attempting another IVF cycle, Couvaras says.
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