Three IVF implantation failure factors – and one red herring – covered off with an expert team
IVF implantation failure – unpacking the problem
A failed IVF cycle really, really puts you through the wringer. Having been there personally, I know just how heartbreaking it feels.
Your head spins and you want to know why. Reading every IVF and fertility blog and post under the sun (and only feeding that lovely algorithm) can leave you even more confused about why it didn’t work.
We’ve picked up with the fertility specialists at Europe’s top-drawer fertility clinic IVF Spain, to unpack three key factors (and one often-misunderstood concern) thought to impact implantation failure.
Keep reading for our Q&A, with Fertility Specialist Dr Natalia Szlarb, MD, PhD.
1. Luteal phase insufficiency (the red herring)
During controlled fertility treatments like IVF, the length of a woman’s luteal phase isn’t a major concern – it can be managed and regulated with progesterone support.
If a woman has a naturally short luteal phase (meaning a short cycle overall), this is easily addressed during treatment and typically doesn’t pose a problem.
But what about natural conception – what are the symptoms of a luteal phase defect?
The key sign of luteal phase defect or insufficiency is bleeding very soon after ovulation – sometimes just two days later, which is far too early for implantation to occur.
This tends to be more noticeable in women with cycles shorter than the typical 28 days.
What causes a short luteal phase?
The most common cause is luteal insufficiency, when the body doesn’t produce enough progesterone to adequately prepare the uterine lining for implantation and early pregnancy.
Can you lengthen your luteal phase?
Yes. Since a short luteal phase is typically caused by low progesterone, increasing this key hormone is the most effective way to lengthen the phase.
In fertility treatment, a specialist can regulate your cycle using progesterone to achieve the best possible outcome. Progesterone support comes in several forms, and your fertility specialist will provide guidance on the right option for you.
2. Embryo quality and testing – plus, your endometrium
If a high-quality embryo doesn’t implant, is the issue with the body?
With IVF and fertility treatment, it’s easy to assume a great-looking embryo equals a high chance of pregnancy. Under the microscope, an embryo might appear top-tier in terms of structure and development. But appearance doesn’t always tell the full story. Genetically, it may still be abnormal.
To check whether an embryo is genetically normal, we need to examine its chromosome count. That’s where preimplantation genetic testing for aneuploidy (PGT-A) comes in (previously known as PGS).
PGT-A allows embryologists to analyse the full set of 23 pairs of human chromosomes in embryos created via IVF. This gives us a clearer picture of which embryos are chromosomally normal, regardless of how they look under the microscope.
Age also plays a major role.
- In women aged 20 and under, 80% of embryos tend to be genetically “good quality.”
- By age 30, this drops to around 50%.
- At age 40, the number falls to 20%, and
- By 43, it’s down to just 10%.
Because of this natural decline, we recommend PGT-A for anyone over 35 to help improve the chances of identifying viable embryos earlier on in the IVF process.
What about scratch and ERA tests – are they effective?
At IVF Spain, we use the endometrial receptivity map (ER Map), which is a personalised test that diagnoses the receptivity status of the endometrium (the womb lining) during the implantation window.
Understanding this timing (when your endometrium is most receptive) is a game-changer. With the ER Map, we can pinpoint the moment of optimal receptivity, helping to increase the likelihood of successful embryo implantation, pregnancy, and overall IVF success rates.
Here’s how it works:
The ER Map is currently the only endometrial receptivity test that also examines gene responses linked to implantation. It’s a molecular tool based on the expression analysis of 48 genes involved in endometrial receptivity and the immune response related to embryo implantation.
In short, it helps us personalise the timing of embryo transfer. And that can make all the difference.
3. Stress
Can stress cause implantation failure?
Stress is never good for our health, and that includes fertility. Anything that negatively impacts your body can also affect your chances of getting pregnant. So yes, chronic or high levels of stress can play a role in implantation failure and the overall success of fertility treatment.
We need to acknowledge here that treatment itself can be a major source of stress. IVF and similar paths often involve uncertainty, emotional strain, and constant waiting, all of which take a toll.
At IVF Spain, we help patients tackle stress with a three-step approach. Whichever clinic you’re with, look for their support on these specific areas:
- Reducing unpredictability.
We provide clear, transparent information about every stage of the fertility journey – from tests to treatments – so nothing feels confusing or out of your control. - Personalising treatment.
We tailor each plan to the individual, walk patients through IVF success rates, and offer realistic expectations at every step. - Offering emotional support.
Ongoing guidance and care are key, and no one should go through this alone.
Stress may be inevitable but it doesn’t have to be overwhelming, especially with the right information, plan, and support team in place.
4. Lifestyle
Can lifestyle changes help prevent implantation failure?
The short answer: yes, they can make a real difference. A healthy body is better equipped to respond to fertility treatment, and simple lifestyle shifts can help create the best possible environment for implantation.
The basics still stand – quit smoking, eat well, stay active, and try to minimise stress where you can.
That said, we know infertility is an emotional rollercoaster. Guilt, shame, anger, helplessness – these feelings are completely valid, but they can also contribute to chronic stress, which isn’t ideal during treatment.
If you’re looking for ways to manage that stress, options like massage and acupuncture can be helpful in creating a sense of calm and comfort during your journey.
Any advice for TRB readers who’ve experienced repeated implantation failure?
In cases of repeated implantation failure, I recommend considering PGT-A (Preimplantation Genetic Testing for Aneuploidy).
PGT-A is a form of preimplantation genetic testing that looks for numerical chromosomal abnormalities in embryos. This technique is particularly recommended for patients with known chromosomal issues, low egg quality, or a history of repeated implantation failure.
A heartfelt thank you to Dr Szlarb and the team at IVF Spain for sharing their insight into implantation failure. If you have more questions or would like to explore your next steps, the team are on hand to help – connect now to get the ball rolling.
