The Hormone Puzzle Podcast - Learn How to Solve Your Infertility Puzzle to Get and Stay Pregnant · Dr. Kela Smith - Fertility and Hormone Doctor

Repeat Implantation Failure- Why It Happens and How to Fix It with Dr. Nadine Al-Kaisi

·44 min·3 clips

Dr. Nadine reveals how your immune system's killer cells might be attacking embryos during implantation.

Dr. Kayla Smith hosts fertility specialist Dr. Nadine Al-Kaisi to explore the complex issue of repeat implantation failure (RIF). Dr. Al-Kaisi is a fertility doctor and endocrinologist who founded a consulting practice after observing standardized, impersonal care in many U.S. clinics. She contrasts the more holistic, explanation-driven German fertility approach with the sometimes corporate U.S. model, where patients often seek deeper understanding before proceeding to interventions like IVF. The official definition of RIF is the failure to achieve pregnancy after transferring three high-quality embryos. Dr. Al-Kaisi emphasizes that unexplained infertility is a starting point for investigation, not a final diagnosis. Key areas to investigate include clotting disorders, which can disrupt new blood vessel formation essential for implantation. Endometriosis is another major cause, though it can be asymptomatic and difficult to diagnose without laparoscopic surgery. Chronic endometritis, a uterine infection often detected via endometrial microbiome testing or biopsy, is a more recently recognized factor. The conversation covers immune system factors, specifically natural killer (NK) cells, which may attack embryos perceived as foreign tissue. Potential treatments for elevated NK cell activity include intralipid infusions, which are derived from soy and may block cell receptors without significant side effects. A surprising insight is that 40% of unexplained infertility cases may be undiagnosed endometriosis, even in patients without classic symptoms. Dr. Al-Kaisi notes that a history of a successful prior pregnancy can still be followed by secondary infertility linked to chronic endometritis. She points out the practical challenge of conducting controlled fertility studies, as few patients are willing to be in a placebo group. Emerging research involves using AI to analyze embryo development and testing the fluid embryos grow in for immune markers to predict implantation success. For immediate action, she recommends at-home vaginal microbiome testing if a doctor is unwilling to perform an endometrial test. Dr. Al-Kaisi advises men to undergo sperm DNA fragmentation testing in RIF cases and to avoid vaping, as toxins significantly impact sperm health. She stresses that patients should not hesitate to change doctors if they feel unheard, as the patient-doctor relationship is critical in this vulnerable journey. The tone is educational and supportive, blending clinical explanations with empathetic, practical advice. This episode is ideal for listeners experiencing unexplained infertility or failed IVF cycles who seek a root-cause, investigative approach. Those looking for a strictly conventional medical perspective or quick fixes might find the discussion of holistic testing and controversial therapies less appealing.

As heard by us

A measured look at RIF testing gaps and the still-controversial immune therapies around them.

The episode frames repeat implantation failure as a problem to investigate, not a puzzle to romanticize. It moves through endometrial microbiome testing, plasma cell biopsy-style sampling, and the possibility that a past chlamydia infection may still matter even when microbiome…

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Get a clearer map for repeat implantation failure and the testing around it.

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