Is there anything I can be doing differently next time?

We received this email from Katharine, who needed to understand why her beautiful embryo didn’t implant

“2020 was horrible. Not just because the world went in to shut down as millions of people lost their lives to the Coronavirus, but because I failed my first round of IVF. My beautiful embryo just did not want to implant and I am utterly devastated.

“This year has to be better. I need to make it work. I need to know what I can do to maximise my chances of becoming a mother.

“I need to know why my IVF failed and what I can do differently next time.

“I know you don’t know my personal case, but can you give me some more information about possible changes following a failed round of IVF that I could discuss with my doctor.

“Huge thanks, Katharine”

So, we passed Katharine’s questions over to the team at Clinica Tambre.

Why would a perfect embryo not implant?

There are many reasons why a “morphologically perfect “embryo may not implant. The main reason is the embryo itself. Despite the morphology, embryos that have alterations in their chromosomes, normally do not implant.

Apart from that, some other reasons are:

Clotting alterations: some alterations in the blood clotting may also affect the implantation chances. Sometimes, it is recommended to add aspirin or heparin to minimise the effect of those alterations.

Immunological alterations: occasionally, an immunological examination is highly recommended to discard some issues that should be treated.

Displacement of the Window of implantation: the window of implantation (WOI) is the period of time when the endometrium is ready for the embryo implantation (so the endometrium is receptive). Some patients may have shifts in that WOI so the embryo may have lower chances of implanting.

I read that sometimes it is better to freeze an embryo and then transfer at a later stage, when the body has had time to recover and settle from the stimulation. Is this correct? Can the lining be the right thickness but still not be receptable?

 Currently, there is a slightly higher chance of implantation with a fresh embryo but sometimes it may not be recommended. For instance, if there is a high risk of ovarian hyperstimulation syndrome or some endometrial problems.

Regarding the endometrium lining, there is no relation between the endometrial thickness and the endometrial receptivity. Firstly, the endometrium should be thick enough and then, it should be receptive. In around 70 % of women, that endometrial receptiveness (window of implantation) is known to appear 5 days after starting the progesterone (in case the embryo to be transferred is in its blastocyst stage) but in the rest of them, the window of implantation could be shifted.

 How do you decide if a patient should have a fresh or frozen embryo transfer?

In general, if the patient´s condition is fine, the first embryo transfer is done with a fresh embryo but sometimes it is necessary to freeze the embryos and postpone the embryo transfer. In situations such as:

Risk of ovarian hyperstimulation syndrome: a fresh embryo transfer could make the symptoms worse and therefore it is highly advisable to freeze the embryos to reduce the risk of severe medical complications.

Endometrial problems: some endometrial conditions like thin endometrium, intracavity fibroids, endometrial polyps, unexpected vaginal bleeding may make the doctors decide to freeze the embryos until those problems solved before an eventual embryo transfer.

Need of PGS testing: as the genetic results normally need some days to be ready, it is very common to freeze the embryos until the PGS results are available.

What are your thoughts on the ERA test? Would you say that it is important to have this test?

 The ERA (Endometrial Receptivity Analysis) is a genetic test to check when the best moment to do the embryo transfer is, that is, when the window of implantation is.

This test is recommended after 1 or more failed embryo transfers, especially if the embryos had high quality and will help us in personalizing the embryo transfer so that the next embryo transfer could be done in the moment when the endometrium is receptive.

Do you think PGS testing is an important test to have following a failed round of IVF?

The importance of PGS testing after a failed cycle of IVF will depend mainly on the woman´s age and the kind of treatment she is undergoing.

In general, if the patient is undergoing an egg donation treatment, it is not very likely that the main cause of a failure of implantation is the embryo´s aneuploidy (alteration of the chromosomes).

In contrast, if the woman is undergoing IVF with her own eggs, especially if she is older than 38 years old, it is highly recommended to do PGS on the embryos to select the healthy ones  (euploid) to be transferred afterwards as it´s known that the older the woman gets, the higher the chance of having a aneuploid embryo is. Those aneuploid embryos do not normally implant but occasionally they may implant and the pregnancy may end in a miscarriage.

In addition, patients with recurrent miscarriages, severe male factor or karyotype alterations are frequently advised to do PGS testing also.

 Is there anything I might have done wrong?

 It is important to follow your doctor´s advice regarding the activities you may have and the medication to take. If you stop the hormonal medication or forget to take it, it could affect the implantation process. Apart from that, it is very unlikely that you might do something wrong that could affect the implantation itself.

Is there anything I can do to make sure I have done as much as possible to make that embryo implant?

It is recommended to follow your doctors advice  as well as trying  to have a healthy and relaxed way of life if possible.

Thank you so much to Clinica Tambre for answering Katharine’s questions. If you have any of your own questions that you need answers to, drop us a line at info@ivfbabble.com