Implantation failure





Whenever we talk about female infertility we think ovulation is the only factor for infertility but along with this implantation failure also contributes to infertility in many cases.

But before knowing implantation failure we must know what the implantation process is?

Definition of implantation.

Implantation is the process of attachment of fertilized egg i.e. zygote with an endometrial wall Uterus. When a zygote form (by the meeting of an ovum with sperm) it must get attach to the uterine wall to get nourished and can grow into a fetus.

It is a slow and crucial process that can take 3-5days to get completely embedded into the uterine endometrium. As it starts to dig the endometrial lining there is the secretion of HCG (human chorionic gonadotropin hormone) from the endometrial tissues which are in touch with the embryo.

HCG hormone will protect new in growing tissue of zygote from the immune response of the mother body. HCG, increase the acceptance of the mother uterus for the embryo to implant in it.

After the implantation process has completed the formation of chorionic villi occur which sucks blood and nutrient directly from the uterus. So Problem with implantation leads to infertility.

 

There are 4 factors responsible for implantation failure


  1. Endometrial problem: During the follicular phase of the menstrual cycle i.e. just after the bleeding phase uterus starts to make new endometrial lining under the control of estrogen secreted by growing follicle in ovaries. More than 8 mm thickness of endometrium considers favorable for implantation. In females having hormonal imbalance or having low estrogen levels in the body can face thin endometrium or of less than 7 mm if thickness at the time of ovulation. Endometrium thickness can be measured while follicular study. Normal endometrial growth rate is 0.5-1mm/ day .If it is less than that could be enhanced with estrogen supplement and circulation booster medicine.
  2. Maternal immunity factors: As implantation started HCG hormone secreted which maintain the necessary level of. Estrogen and progesterone to support pregnancy. As progesterone Suppress immune response in the mother body which awakens due to new tissue embedding into uterine wall .otherwise, mother immune tissue considers embryo as a foreign body and they kill it. In some cases where a history of autoimmune disease or any infection is there. The immune suppressor is given to protect the embryo.
  3. Infection or hydrosalphinx: It is also a reason for implantation failure. Previous infection or hydrosalphinx or any other infection of the uterus and fallopian tube hinders the implantation process as immune cell are present in large amount in the uterus .it kill embryo as they consider it as a foreign body.
  4. Abnormal karyotype: If an embryo contains an abnormal set of chromosomes (sex chromosomes or autosomes) then also it can implant normally.

 

CONCLUSION

Out of this four-factor starting, 3rd factor can control easily. Whereas the 4th one requires genetic selection of gamete in IVF cycles.

1)     Endometrial factor can be treated by giving medicine to increase circulation and to increase estrogen level so that endometrial thickness can be more than 8 mm.

2)     Immune response can be suppressed by an immune suppressor drug that is safe for pregnancy.

3)     infection and hydrosalphinx should be treated with antibiotics and suitable drugs  first before trying for getting pregnant,

4)     Abnormal karyotype of the embryo can be avoided by genetic selection of gamete before fertilization.

        

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