The reasons for a negative outcome in an assisted reproduction attempt are varied and complex. It is essential for the physician to assess and prioritize the causes of failure for each couple to increase their chances of success in future attempts. The investigation typically focuses on three key areas: embryo quality, the intrauterine environment, and the woman’s immunological and hematological status.

 Embryo Quality

The quality of the embryos is a critical factor for the success of IVF and can be influenced by several factors, including:

• Biological age of the patient: Age affects the quality of eggs and, consequently, the quality of the embryos.
• Ovarian pathologies: Conditions such as endometriosis and polycystic ovary syndrome (PCOS) can negatively impact egg quality.
• Sperm quality: The quality of the partner’s sperm is equally important for fertilization and embryo development.
• Ovarian stimulation protocol: The correct choice and application of the stimulation protocol are vital for producing good-quality eggs.
• Proper oocyte retrieval and fertilization: Accurate techniques in egg retrieval and fertilization procedures are essential for creating healthy embryos.
• Embryo culture: The embryos are cultured in the embryology lab, and their implantation potential is evaluated by embryologists with the help of artificial intelligence.

Intrauterine Environment

The intrauterine environment plays a crucial role in the successful implantation of the embryo. Key factors that must be assessed include:

• Endometrial thickness: The endometrial lining should be greater than 7mm, with a trilaminar structure and adequate vascularization.
• Endometrial polyps and fibroids: Polyps and submucosal fibroids should be removed, as well as large intramural fibroids, as they can interfere with conception or the progression of the pregnancy.
• Endometritis: Inflammation of the endometrium (endometritis) can impair implantation and should be treated. Diagnosis is made through hysteroscopy, detection of cd138, and microbiome sampling. If endometritis is confirmed, appropriate antibiotic treatment should be administered before re-evaluating the endometrial space.

Immunological and Hematological Factors

A woman’s immunological and hematological status can significantly influence the outcome of IVF. Important aspects to investigate include:

• Antiphospholipid syndrome
• Blood coagulation disorders
• Acquired and genetic thrombophilia
• Hematological diseases
• Natural killer (NK) cell activity
• Systemic lupus erythematosus
• Rheumatoid arthritis
• Other rare rheumatic diseases

Conclusion

Each couple that experiences IVF failure should undergo thorough evaluation across all of these axes to address potential issues and improve their chances of success in future attempts. Proper diagnosis and targeted treatment can significantly enhance the likelihood of achieving a successful pregnancy.