Embryo implantation disorders

Question 1

Describe the process of embryo grading.

Answer 1

First number= number of cells
Second number= idealised blastomeres (out of 4)
Third number= level of fragmentation (<10%=4, 10-20%= 3)

Question 2

Describe the process of blastocyst grading.

Answer 2

1 to 6 on the level of blastocyst expansion with 5 being in the process of hatching and 6 being fully hatched.
A-D for inner cell mass quality with A= numerous highly packed cells
A-D for trophoectoderm quality A= numerous cells closely packed.

Question 3

Describe the 3 factors which are required for successful implantation.

Answer 3

Receptive endometrium (implantation window day 6-10)
Developed good quality blastocyst
Maternal/baby cross talk

Question 4

Compare a receptive vs non-receptive endometrium.

Answer 4

Receptive= Short microvilli, no negative charge, thin mucin coat, pinopodes present 
Non-receptive= Long micro villi, negative chargem thick mucin.

Question 5

What is a pinopode and where might you find them.

Answer 5

Cellular protrusions found on a receptive endometrium.

Question 6

Describe the process of implantation.

Answer 6

Day 5= free floating blastocyst
Day 6= Hatching from zona
Day 7= blastocyst aposition
Day 8= blastocyst adhesion, LIF expression is greatest at this point.
Day 9 blastocyst invasion, trophoblasts differentiate into inner cytotrophoblasts and outer syncitiotrophoblasts.
Day 10 close of implantation window.

Question 7

Define repeated implantation failure.

Answer 7

No clinical pregnancy after 3 cycles of implanting 4 good quality embryos in an individual under the age of 40.

Question 8

Describe what issues with the embryo could cause implantation failure.

Answer 8

Egg- Low ovarian reserve
Iatrogenic
Age
Genetic

Question 9

Describe what issues with the endometrium/ uterus could cause implantation failure.

Answer 9

Uterine septum
Congenital abnormalities e.g. bicornuate uterus
Polyps= outgrowths of endometrium
Fibroids= outgrowths of the uterine musclar wall
Adhesions e.g infection, ashermans, surgery.
Mullerian dysgenesis - bleeding into the wall
Adenomyosis.

Question 10

Describe what issues with the Fallopian tube could cause implantation failure.

Answer 10

Adhesion’s e.g. chlamydia

Hydrosalinges - tubes are blocked with fluid.

Question 11

Describe what endocrine issues could cause implantation failure.

Answer 11

Thyroid dysfunction e.g. hyperthyroidism
Diabetes mellitus
PCOS

Question 12

Describe what autoimmune issues could cause implantation failure.

Answer 12

Autoimmune gonadal conditions
Autoimmune thyroid
Antiphospholipid syndrome

Question 13

Describe the investigations you could preform to rule out egg related causes of implantation failure.

Answer 13

Tests for the ovarian reserve-
Basal FSH- day 2-3
AMH
Antral follicle count

Question 14

Describe the investigations you could preform to rule out endocrine related causes of implantation failure .

Answer 14

Thyriod- TFT, thyroid peroxidase
PCOS- testosterone, sex hormone binding globulin, free androgen index
Diabetes mellatus- Hba1c

Question 15

Describe the investigations you could preform to rule out autoimmune related causes of implantation failure .

Answer 15

Antiphospholipid antibodies

Thyroid function

Question 16

Describe the investigations you could preform to rule out structural related causes of implantation failure .

Answer 16

Hysteroscopy

Hysterosalpinography