11 May 2021

Melbourne IVF fertility specialists propose an algorithm to personalise the diagnosis of repeated embryo implantation failure.

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Melbourne IVF

Repeated failure of embryo transfers with IVF treatment, or recurrent implantation failure (RIF), is devastating for patients. For clinicians, the disorder provides significant diagnostic and therapeutic challenges.

Fertility specialists from Melbourne IVF are calling for a more precise and updated definition of RIF, to help improve patient counselling and when additional investigations should be considered.

The researchers also propose a new concept termed ‘Theoretical Cumulative Implantation Rate’, the calculation of which is based on objective data, to define whether a patient should be diagnosed with RIF.

Dr Genia Rozen, Melbourne IVF Fertility Specialist explains how she hopes the new concept will address the shortcomings in the widely used definition of RIF.

“Our concept aims to improve clinical decision making with more individualised and scientific approaches towards investigations. RIF is not a diagnosis in itself and we hope our algorithm can reduce unwarranted testing and therapeutic interventions.

Dr Rozen explains the idea stems from a simple but critical question: What is the number of failed embryo transfers before further investigations commence to uncover pathology?

“Our algorithm, ‘Theoretical Cumulative Implantation Rate’ (TCIR) can be calculated based on objective data. Each embryo transferred following an IVF cycle has a theoretical implantation rate (TIR) based on different factors. For example, female age, embryo quality, embryo grading, cycle details, chromosomal normality (for tested embryos) and inter-laboratory variability.

“The concept involves incorporating all the factors which may impact the chance of pregnancy, based on logical and consistent criteria, which can be flexibly tailored to an individual patient.

“We propose that an individual’s TCIR can be calculated by combining the implantation rate for each embryo transfer attempt. Clinicians can use a table, to work out their patient’s individual theoretical implantation rate.

Dr Rozen said calculating a personalised TCIR would be an improvement on existing clinical practice due to incorporating all factors which may impact the chance of pregnancy.

“This can in turn influence areas such as patient counselling. It would help with more consistent timing of initiating investigations, as well assist in the planning of research studies on RIF,” said Dr Rozen.

Dr Rozen highlights that at the primary care level, GPs play a vital role in the ongoing counsel of patients who have failed to conceive with IVF.

“Often patients turn to their GP for help after repeated failed cycles, so its imperative GPs have insight into this condition, to help support patients.

Dr Rozen believes it’s important for patients to understand their chances of pregnancy with their transferred embryo as well as their theoretical pregnancy chance after a number of transfers. It often helps to reassure patients that success is still likely, and a stronger recommendation that they should in fact continue with IVF treatment. This information also reduces the pressure to commence investigations and/or therapies which are not strongly ground in evidence.

“On the other hand, a personalised TCIR may also be used as a tool to guide patient decision making around the cessation of treatment with autologous gametes and consider moving towards donor eggs/sperm/embryos.

“The use of this tool to manage patient expectations may lead to increased satisfaction and reduce treatment dropout, culminating in higher cumulative pregnancy rates.

Dr Rozen explains that from the clinician point of view, TCIR may ease the pressure to comply with requests from those desperately seeking unwarranted diagnostic investigations or adjuvant treatments.

“We hope this concept to refine and utilise the RIF definition can now benefit from expert opinion and pilot studies to test its utility in clinical practice,” said Dr Rozen.

Dr Rozen explains that Melbourne IVF places great emphasis on research and development and has a large ART research program with high patient numbers, allowing lots of scope to explore and optimise clinical practice, to find ways to fine tune and improve outcomes for our patients.  

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