Understanding Recurrent Implantation Failure In IVF : Dr. Hrishikesh Pai Sheds Light on Causes & Solutions

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Recurrent Implantation Failure (RIF) continues to be one of the most frustrating and emotionally draining challenges in assisted reproductive technology. Defined clinically as the failure to achieve a pregnancy after the transfer of at least four good-quality embryos in a minimum of three fresh or frozen IVF cycles, RIF demands more than routine IVF protocols. At the forefront of tackling this complex condition is Dr. Hrishikesh Pai, one of India's most experienced and decorated IVF specialists, who brings over four decades of advanced clinical and research-based fertility care to patients from around the world.

Understanding The Multifactorial Nature Of RIF

As a leading IVF doctor in Mumbai, India, Dr. Pai has made it his mission to decode the underlying causes of failed implantation, especially in cases where previous cycles have seemingly gone well. "RIF is not just about failed embryo transfer. It's a multifactorial issue-ranging from genetic anomalies and hormonal imbalances to immunological dysfunctions and subtle uterine pathologies," says Dr. Pai. "That's why a one-size-fits-all approach will never work. What patients need is a stepwise, precision-driven diagnostic and treatment protocol."

Advanced Genetic Screening : The Role Of PGT-A

At Bloom IVF, under Dr. Pai's direction, patients presenting with suspected RIF undergo an exhaustive evaluation starting with karyotyping of both partners. Chromosomal translocations or structural abnormalities, though often asymptomatic, can compromise embryo viability. In such cases, Preimplantation Genetic Testing for Aneuploidy (PGT-A) becomes indispensable. "Transferring euploid embryos, especially in women over 35 or those with repeated IVF failures, significantly enhances implantation rates and reduces miscarriage risk," explains Dr. Pai.

Hormonal Evaluations And Endocrine Optimization

Hormonal dysfunctions are another silent contributor. "Even borderline thyroid dysfunction or elevated prolactin levels can impair endometrial receptivity," Dr. Pai shares. To address this, all patients undergo a comprehensive endocrine profile, including thyroid function tests, prolactin levels, insulin resistance screening, and glycemic control evaluations. Correcting these parameters can lead to a marked improvement in implantation outcomes.

Addressing Immunological Barriers To Implantation

What sets Dr. Pai's protocol apart is his meticulous focus on immunological causes-an area often overlooked in standard IVF evaluations. Utilizing advanced immune profiling, including testing for Natural Killer (NK) cell activity, antiphospholipid antibodies, and other autoimmune markers, Dr. Pai has been able to identify and manage immunological barriers that affect implantation. "Immunotherapy in select patients-using low-dose steroids, intralipids, or anticoagulants-has shown encouraging results," he states.

Anatomical Assessments And Hysteroscopic Corrections

Anatomical factors are also carefully ruled out using high-resolution 3D ultrasound and diagnostic hysteroscopy, which help visualize intrauterine adhesions, septa, or micro-polyps that may not appear in conventional scans. In some cases, Dr. Pai performs minimally invasive hysteroscopic correction to restore uterine integrity and optimize implantation conditions.

Male Factor Considerations And The IMSI Advantage

For male factor cases, Dr. Pai emphasizes the importance of IMSI (Intracytoplasmic Morphologically Selected Sperm Injection)-a technology he introduced in India as early as 2007. By selecting sperm at 6,000x magnification, IMSI significantly improves outcomes for couples with high sperm DNA fragmentation or severe teratozoospermia. "When we combine IMSI with euploid embryo transfer and a receptive endometrium, we see implantation rates that were previously unimaginable in RIF cases," Dr. Pai adds.

Combining Innovations For Higher Success Rates

According to recent global studies, the implantation rate with PGT-A screened embryos ranges between 60-70%, and when combined with tailored protocols like those at Bloom IVF, live birth rates improve even after multiple failed attempts. Dr. Pai's own clinical data reflects an IVF success rate of 40-50% per cycle, which increases further when advanced diagnostics and embryo screening are incorporated.

A Case Study : Turning Repeated Failures Into Success

Dr. Pai recounts a recent case of a 38-year-old patient with five previous failed IVF cycles. "We found a septate uterus on 3D ultrasound, a borderline TSH level, and embryos with chromosomal abnormalities. After surgical correction, thyroid management, and a PGT-A guided embryo transfer, she conceived in the very next cycle. These are the kinds of results that make our work deeply fulfilling."

Leading The Way In Precision Fertility Care

Globally recognized for his innovations in assisted reproduction, Dr. Hrishikesh Pai has received over 45 national and international awards, including the ISAR Late Dr. Prabha Malhotra Memorial Lifetime Achievement Award, ET Healthworld IVF Legend Award, and the FRCOG (London). His practice reflects the highest standards in fertility care-merging clinical precision with empathy.

"Every IVF failure is an opportunity to learn more about the patient's reproductive ecosystem," Dr. Pai says. "When we dig deep and customize each step, success is not a matter of chance-it becomes a matter of time."

For appointments and detailed consultations:

Dr. Hrishikesh Pai
Bloom IVF Group, Lilavati Hospital, Bandra (W), Mumbai
https://drhrishikeshpai.com/
About Dr. Hrishikesh Pai

Dr. Hrishikesh Pai is one of India's most accomplished IVF specialists, with over 40 years of experience in reproductive medicine. As the Founder and Medical Director of Bloom IVF Group, he has pioneered several fertility innovations in India, including IMSI, oocyte freezing, PGT, and assisted laser hatching. Known for his high success rates and compassionate care, Dr. Pai continues to transform the lives of couples facing infertility through his evidence-based, personalized approach.