Endometriosis, Infertility, and Recurrent Implantation Failure

Endometriosis can be associated with increased rates of infertility. In natural conception, once the egg is fertilized, the embryo travels to the uterus and eventually attaches itself to the uterine wall. This process is called implantation and it is essentially considered to be the beginning of pregnancy. For the endo warriors that are undergoing infertility or assisted reproductive treatment, you might find that your infertility specialist diagnoses you with Recurrent Implantation Failure.

Currently, there is no agreed-upon definition for Recurrent Implantation Failure (RIF), however, it generally refers to women with a history of good embryos and three to four IVF treatment rounds without achieving a successful clinical pregnancy.¹ RIF can be an incredibly frustrating and disheartening experience, especially in combination with the fertility issues associated with endometriosis.

Increasing rates of success

If you have a history of RIF, your infertility specialist will use a few methods to increase the likelihood of a successful pregnancy. These are individually prescribed according to your medical history. Generally, IVF specialists address RIF via 3 methods: techniques that work directly in the uterine cavity, specialized laboratory testing of the sperm and embryo prior to fertilization or transfer, and therapies that alter your body’s immune response to the fertilized embryo and the implantation process. There is moderate evidence to suggest increased success in RIF with the administration of peripheral blood mononuclear cell (PBMC) subcutaneous or intrauterine granulocyte colony-stimulating factor (G-CSF) results in reduced rates of RIF and increased pregnancy rates.²

Am I to blame for my recurrent implantation failure?

Infertility treatment can take a long time and can be a physically and emotionally draining experience. It is not uncommon for endometriosis sufferers to feel that infertility is directly "their fault". When it comes to fertility, it is really important to remember that the blame game in infertility treatment doesn’t really serve a purpose. This includes the private, and unspoken blame we place on our own shoulders as endo warriors. In fact, heading down that path can be detrimental to your relationship as well as your self-esteem and resilience. Despite this, it is really important to work out exactly what factors are contributing to the implantation failure so that your infertility team can help them to be resolved. As part of this analysis, both partners need to remember that there are female and male factors that can increase the risk of RIF-related infertility, even if you have endometriosis.³

Lifestyle changes to support healthy implantation

While your infertility team will be doing all they can to avoid further implantation failures and improve your chances of success, there are some lifestyle factors that you and your partner can modify that may increase your chances of a successful pregnancy.¹

• Stop tobacco consumption. Maternal and paternal smoking will increase your chances of RIF.
• If you are overweight or suffering from obesity, maintaining weight within a healthy range is associated with greater success.
• Avoid or reduce alcohol consumption to keep it within your country's alcohol consumption guidelines. However, if you find you can’t avoid alcohol altogether, then one to two standard units of alcohol per week should be your maximum consumption. Furthermore,  just prior to and after embryo transfer, it is best to treat your body as if you were pregnant, and avoid alcohol altogether.³
• Acupuncture has been shown to increase rates of pregnancy and successful implantation in RIF.⁴

In short, if you have begun your IVF journey, it is important to remember that even if you have endometriosis and a diagnosis of  RIF, there are still factors within your control to change that can help to improve your chances of a successful pregnancy. These small modifiable factors in combination with your infertility specialist's recommendations may be what results in your long-awaited positive result.