Recurrent pregnancy loss (RPL) affects 0.8–1.4% of couples, and this prevalence increases with aging. However, etiology is commonly unknown, and most therapies are not supported by strong evidence. There are many examinations that investigate causes of RPL: hormonal status, spermatozoa morphology and DNA fragmentation, immunologic status, uterine assessment, thrombophilia, and others. Recently different types of treatment have emerged, most lacking good evidence. As for example, we may mention the use of anticoagulants, aspirin, corticosteroids, progesterone, and antioxidants and psychological support. It is argued that some procedures such as preimplantation genetic testing for aneuploidy and intracytoplasmic morphologically selected sperm injection would impact on the outcomes and help RPL management. This chapter will discuss the current evidence concerning examinations and treatments that would improve the outcomes in patients with RPL, with recommended practice.
Part of the book: Innovations In Assisted Reproduction Technology
Recurrent implantation failure (RIF) is one of the great challenges of current reproductive medicine. The term refers to the failure of repeated transfers of embryos of good morphological quality. Embryo implantation is a crucial moment in in vitro fertilization (IVF) treatments. A successful pregnancy depends on a synchronized interaction between a good quality embryo and a receptive endometrium. Its failure may be a consequence of embryo quality, anatomical or immunological factors. The anatomic causes constitute an important factor for RIF, although they are usually manageable. Fibroids, polyps and adhesions that develop after a surgical procedure or infection can hamper the embryo - endometrium attachment process. In addition, Mullerian abnormalities and hydrosalpinx can cause a negative impact on implantation rates and should also be taken into account in patients with RIF. In this chapter, we will address the main anatomical causes that may impact the implantation rates of patients undergoing IVF, as well as recommendations on management and its treatment.
Part of the book: Infertility and Assisted Reproduction