Michael A. Feinman, MD, FACOG
PRE-IMPLANTATION GENETIC SCREENING (PGS)
With PGS, day 5 embryos (blastocysts) are sampled and the cells are tested to see if they contain the correct number of chromosomes. While not shown to improve pregnancy rates, this process can help couples determine if their implantation failure is due to abnormal chromosomes in the embryos. After completing the above tests, an IVF cycle with PGS can further help couples understand what is going on if pregnancy still does not occur.
IMMUNOLOGIC TESTING AND TREATMENT
This aspect of implantation failure is more controversial. While the theories about the role of the immune system in causing implantation failure and miscarriages are appealing, much of the reproductive medicine world does not feel these tests or treatments been adequately tested with controlled studies. In theory, the immune system can adversely affect reproduction by two mechanisms. Autoimmune conditions could make a woman’s immune system attack the implanting embryo or pregnancy and it to be rejected. There are rare known conditions like anti-phospholipid syndrome that are known to cause this. Advocates of this approach get large batteries of tests in otherwise healthy women and recommend various treatments based on the findings. The second type of disorder is alloimmunity, where a woman attacks the foreign body implant of her partner’s embryo; much like a kidney transplant. Again, while this probable occurs is some cases, it has been hard to prove that such testing and the subsequent treatment improves outcomes.
If all of the above tests are normal, and embryo quality has been adequate, some immune testing seems reasonable. Through the years, I have looked at which tests make sense and seem to actually impact on results. When appropriate, we offer a limited battery of tests to address this possible problem.
In addition to helping couples overcome infertility, IVF opens a window into why they may not be getting pregnant. A systematic approach to implantation failure can help many couples conceive viable pregnancies after IVF has failed. Sometimes, this evaluation will lead to the conclusion that an egg donor or surrogate is needed. While not the most desired solutions for many couples, coming to this conclusion sooner than later can spare wasted dollars and considerable grief over repeated failed attempts.
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