The causes could be either in the egg, the sperm, in the embryo or the uterus, so how do we understand that the egg is at fault? One is the age. As the age advances there is a decrease in the quality of the oocytes this is a major concern in today’s scenarios. There are lot of women postponing their first child, postponing their marriage first and then they want to complete their careers first before even thinking about their babies or practically they do not have any younger women coming to our clinics asking for a baby at all, The age at which we generally get to see them is around 30 or 31 and there are enough evidences in the literature to state that there is advance in the ovarian age of the women by easily 6 years, which means a women at 30 years when she comes, she has a egg reserve of only of a 36 year old women. 6 years she has already lost. So what can be done? This becomes an irreversible factor because there is no way that nobody can reproduce eggs. Sperms are something which are generated once in 2 to 3 months. Eggs are produced once in the lifetime when she was produced in the womb of her mother. So age becomes a major factor. Apart from age, the other things that can affect the quality is underlying scenarios like polycystic ovary, endometriosis, poor ovarian response and these are all the factors that need correction before they move them on to the IVF or endometriosis which can have a dramatic effect on the quality of eggs that area generated form the varies. As far as the sperm, we have already spoken about correction, the DNA fragmentation, there are tests that can identify and give us, Uterus , that investigation that we would like to do is a basic ultrasound, maybe also a 3D ultrasound, which gives us a better picture of the cavity, hysterosalpingogram, which is nothing but a tubal patency test. It not only gives us information about the tubes, because even if the tubes are dilated, blocked or they have already formed what is called as hydrosalpinges, there also could be major impact in the implantation process and also give us a picture off the uterine abnormalities which could be congenitally acquired, in the sense there could be a double uterus, single ureters, two cervices, two cavities, arcuate uterus, septate uterus, synicae or even an absent uterus. So there are all the abnormalities which can be detected by an ultrasound, by a hysterosalpingogram and a hysteroscopy. These are the ways, the other investigations that we would like to do is a chromosome testing. Though majorly there has been no major incidence of chromosomal abnormalities compared to the general population. But somebody who would come with a repeat implantation failure, we would like to know her chromosomal status. Coming to the immunological mechanisms, the tests towards it, it is a big question to be answered. There are many who feel it is a waste of expenditure and time and energy, what we understand by the immunological tests is that if he or she undergoes a kidney transplant, we have always heard of the kidney being accepted or rejected, there is some phenomenon called as the host versus graft rejection factor. So when the embryo contains some proteins derived from the sperm which are foreign to the mother, the immune mechanisms of the mother have to be dampened. Only then she would accept that embryo. If she has a heightened immunological mechanisms, her defence mechanisms are so strong, she is going to keep rejecting. So this is the debate where we need to do those tests or not to do, but it is a practise and the patient undergoes repeated embryo transfer and is unable to conceive if there are subtle aberrations.

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