Last week we received a question from one of our readers about recurrent implantation failure. She is so frustrated because all of the tests she’s had have come back to say everything is OK!
Many of you can relate to this and have told us that sometimes you almost want there to be a problem so that you can at least know how to fix it and move on.
So we turned to Dr Peter Kerecsenyi from Manchester Fertility to answer our reader’s question and to explain what implantation failure is and what can be done to reduce the risks
Q: “Hi, what can I do to help with implantation? After 3 failed IVF’s I’ve been told I have implantation failure. I would like to know what I can do to help with this for the next round. I have had all the tests done, blood clotting etc and everything has come back normal. My lining is always thick and my uterus is healthy.”
A: “Implantation failure is a term generally used in cases when usually good quality embryos are placed into a well prepared uterus 3 times but no pregnancy is achieved. However, this is not an absolute term and the chance of a successful embryo transfer on your next round can be still quite high.
The most common reason for implantation failure is chromosomal abnormality
At a young age, the chances of implantation failure is around 30-40%, but once you reach 40 years of age, the chances increase to around 50-70%. At the age of 43 around 80% of embryos may not develop into a pregnancy because of an abnormal set of chromosomes.
These embryos may look like perfect blastocysts at the time of embryo transfer, but only a few will implant.
Some clinics offer genetic testing, which is great for a woman of a more advanced age who has created a great number of good embryos.
If the embryo quality is low according to the laboratory scoring, it will reduce the chances of implantation significantly.
Often poor sperm quality is the key factor leading to poor embryo quality.
More recently, highly fragmented sperm DNA has been found to be a possible reason for implantation failure
DNA fragmentation can be tested from semen tests and treatment to improve results is usually simple and straightforward.
Good preparation of the uterus is paramount
An ultrasound is used to measure the structure and thickness of the lining (endometrium). The optimal thickness is at least 7mm. The structure should be regular and tri-layered.
Conditions like endometriosis, adenomyosis, scarring after surgery or infection, fibroids or polyps distorting the cavity, fluid filled or blocked fallopian tubes will all reduce the chances of implantation. In some cases a hysteroscopy is recommended.
A thin endometrium also reduces chances of implantation. An increased dose and prolonged oestrogen treatment along with treatment to increase blood flow can be successful. If there is a normal structure, an endometrium can be receptive even at 4 mm.
The amount and timing of the supporting hormones are crucial. In a fresh IVF cycle, a high oestrogen level or early rise of progesterone can affect the endometrium negatively and, in these cases, embryo freezing and replacement in an unstimulated cycle gives a better chance.
In hormonally regulated cycles, injectable progesterone is offered as vaginal hormone absorption can be insufficient.
The endometrial receptivity analysis (ERA test)
Endometrial receptivity analysis (ERA test) was recently introduced to check the correct timing of an embryo transfer. It is suggested that changing the timing of an embryo transfer, in 20-25% of recurrent implantation failure cases, is necessary to achieve a pregnancy.
Other recommended tests
As well as tests for blood clotting and thyroid function, a vitamin D test is recommended. Coeliac disease (gluten insensitivity) can greatly reduce the chances of pregnancy. Irritable bowel syndrome may be a sign that there are issues with the lining. In the case of a positive test result for IBS, a gluten free diet is beneficial. Absorption problems can lead to folic acid and iron deficiency and correction is necessary.
Several studies suggested that the endometrial scratch before embryo transfer may improve pregnancy chances in cases of recurrent implantation failure. However, the scientific evidence regarding this is mixed and it has not been conclusively shown to improve the chance of having a baby and you would have to discuss this option with your consultant.
Huge thanks to Dr Peter Kerecsenyi. If you have any further questions, then please do call the fantastic team at Manchester Fertility on 0845 268 2244