The implantation failure is the most topical issues in the units assisted and researchers reproduction: why when embryos from in vitro fertilization or No Microinjection Sperm (IVF / ICSI), good quality and in patients implanted with uteri and sonographically normal endometrium, these are not implemented and not the desired pregnancy develops?
Causes of failure of embryo implantation
There are many factors related to that implantation failure. It may be due to:
- Embryonic disorders: although morphologically and dynamically are normal, they may have genetic or its machinery division alterations, which prevents its progression or implantation.
- Immunological factors: r epresentan interaction embryo and the mother. This immunological interaction with various overlaps endocrine, paracrine, coagulation system and inflammation factors.
- Hormonal disorders or endometrial: It is important that the window of implantation, which is the period of time when the endometrium (uterine tissue where embryo implantation will occur) is receptive to occur at the expected time, which can not happen by hormonal or endometrial said local alterations. One of the most common is chronic endometritis (EC).
Chronic endometritis: what is
Chronic endometritis (chronic inflammation of the endometrial lining of the uterus) is usually asymptomatic disease caused by the colonization of bacteria or mycoplasmas endometrial. This disease has no translation and sonographic diagnosis is based on findings:
- Hysteroscopic by visual examination of the endometrial cavity with an optical system. What we see are micropolyps.
- Pathological, based on a study of an endometrial biopsy microscope. What is is an abundance of plasma cells.
- microbiological culture of a tissue sample to check the growth of bacteria and / or mycoplasmas.
How to diagnose chronic endometritis in IVF treatments and relationship (or not) with implantation failure
Since hysteroscopy, endometrial biopsy and cultures are not part of prior to an IVF cycle basic study, the frequency of chronic endometritis in the population is unknown with infertility problems. In the subpopulation with sterile implantation failure studies have found rates ranging from several EC 15%, 30% or 60%.
However, there is no agreement as to the relationship of chronic endometritis respect to implantation failure. While Kasius believes that chronic endometritis not negatively affect the results in terms of pregnancy rates and births after IVF / ICSI, Cicinelli is improved outcomes after hysteroscopic antibiotic and verification. Thus, the pregnancy rate with treated patients is 65% versus 33% in patients who persisted data EC. Also, the live birth rate was 60% versus 13% in patients with CD. Likewise, Johnston-MacAnanny also found a high rate of endometritis in patients IVF / ICSI with implantational failure.
Recommendations and treatment of chronic endometritis
Despite the heterogeneity of opinions and so discordant findings, the expert in Assisted Reproduction recommend in all cases of implantation failure, perform the necessary studies to rule out chronic endometritis by hysteroscopy, endometrial biopsy and culture.
If it is present chronic endometritis proceed to treatment by ten days of antibiotics prior to a new attempt of IVF / ICSI.