(this post will be reviewed and updated soon, but for now...)
Implantation failure….. such a tricky one!
When we start to talk about implantation failure, it's important to really know what that is and what it means.
According to a study I read recently, the term “implantation failure” refers to two different types of cases.
Those in whom there has never been evidence of implantation (no detectable hCG production) and
Those who have evidence of implantation… (detectable hCG production) but it did not proceed to beyond the formation of a gestational sac visible on ultrasonography (1).
Implantation failure is kind of a mis-nomer though. It has been reported that spontaneous pregnancy is achieved in only about 25-40% of healthy fertile women during the first cycle of intended pregnancy.
That means that only up to 4 women in a group of 10 healthy fertile women will conceive in the first month of trying. So it’s much more common that implantation will NOT happen (6/10 women will not conceive)….
not to mention, using the word ‘failure’ has such negative connotations.
When conception doesn’t happen when you’re trying naturally, it’s hard to know where the ‘problem’ actually is. But when you’re having IVF, it’s much easier to come up with a term like ‘implantation failure’… we know an embryo was put into the uterus at roughly the right time.. so then when pregnancy doesn’t happen, it’s easy to start the blame game on ourselves… ‘there was a nice embryo there and now there’s nothing - it must be me’
But this is not really true…There are a number of factors that impact implantation, it’s not all down to the ‘grade’ of the embryo.
The embryo itself… (it has to be chromosomally normal and to have the ‘power’ to keep dividing and growing. Also the ‘grade’ doesn’t always correlate to the chromosomal status),
You could look at doing PGT - pre-implantation genetic testing. This gives more information about the chromosomes in each embryo and allows you to choose the ‘normal’ embryos for transfer. PGT testing is accurate more than 97% of the time. But doesn’t completely eliminate the risk of miscarriage or of ‘implantation failure’
The uterus (the uterine environment and the thickness of the uterine lining will both have an impact)
thickness of the endometrium should be measured prior to transfer and the endometrium should be ‘tri-laminar’. This means that it should have 3 layers
You could look to do testing like the EMMA test which looks at the uterine environment or microbiome. There could be a very low grade ‘infection’ or a slightly overactive microbe in there that is creating a ‘hostile’ environment for the embryo
The timing of the ‘landing’ of the embryo. The embryo has to land in the right place at the right time (in IVF this is the timing of the Embryo Transfer),
You could consider an ERA test. Sometimes these results show a need for a slightly early or later transfer, or extra progesterone
The progesterone levels in the luteal phase (the bit after ovulation, or after embryo transfer).
Progesterone levels during the two weeks after embryo transfer should be carefully considered, measured and (in most cases) supplemented. If you are not getting any progesterone support (pessaries or injections) speak to your fertility specialist!
The immune response. This one is a bit contentious and not supported by the overwhelming majority of fertility specialists. But in repeated cases of ‘implantation failure’ and pregnancy loss - it might be worth considering. Most specialists these days will consider Natural Killer cell testing. There are only a very select few Drs in Australia who will test and treat for DQ Alpha gene testing. I will be interviewing Dr Nick Lolatgis next Wednesday (7th December) and we’ll be talking all about immune testing in IVF… stay tuned to my emails for more information!
Phew! that was a lot!
If you would like to chat about your own individual circumstances or how these apply to your situation… CLICK HERE to find a time
PS If you want to read more about IVF WTF head HERE
PPS if you want to know more about the ERA, EMMA and ALICE tests - head HERE