4 IVF implantation failure factors – unpacked by an expert team

The implantation failure IVF problem

Have you been through the wringer and experienced a failed IVF cycle? Having been there personally, I know just how heartbreaking it feels.

Your head spins and you want to know WHY? Reading every IVF blog and fertility blog out there can leave you even more confused about why it didn’t work.

For this reason, we’ve chatted with the fertility specialists at trusted fertility clinic, IVF Spain, to unpack some of 4 factors thought to impact implantation failure.

Read on for our Q&A, with Fertility Specialist, Dr Natalia Szlarb, MD, PhD, at IVF Spain.

1. Luteal phase insufficiency

How important is the length of the luteal phase?

During fertility treatments, the length of a woman’s luteal phase is not important, as it can be artificially controlled and regulated with progesterone.

In the case that a woman has too short a luteal phase (meaning she has too short a cycle), it will be regulated without a problem.

When trying to conceive, what are the symptoms of a luteal phase defect?

The main symptom of a luteal defect or insufficiency, is if the woman starts bleeding two days after ovulation, which is far too early.

This is noticeable when her cycle is shorter than the normal 28 days.

What causes a short luteal phase?

The main cause of a short luteal phase, is luteal insufficiency.

This can be observed in some women when they cannot produce enough of their own progesterone to prepare the inner lining for successful implantation and pregnancy.

How to lengthen our luteal phase?

The main reason for a short luteal phase is the lack of progesterone, therefore the best way to lengthen it is with progesterone.

This way the phase / cycle can be controlled by the fertility specialist, in order to get the best results.

Progesterone support can be taken in different forms, which your fertility specialist can advise on.

2. Embryo quality and testing

If an embryo that looks high quality doesn’t implant, is the problem with the body?

With fertility treatment and IVF, a good-looking embryo can seem to be of very good quality through the microscope. But, at the same time, it can still be genetically abnormal.

To know if the embryo is genetically abnormal or not, we have to look at the number of chromosomes. For this reason we recommend the Preimplantation Genetic Testing for aneuploidy short PGT-A (before PGS).  This technique allows us to identify the chromosomal status of IVF embryos produced for assisted reproduction, by analysing the 23 pairs of human chromosomes.

Thanks to this technique embryologists know which embryos are genetically abnormal, even if at first sight their appear to be of good quality.

Another important factor is age. Women up until 20 years old have an 80% chance of good-quality embryos, but by 30 this number already decreases by 50%. Then, by 40 years old this reduces even further to 20% and by 43 years old, only 10%.

For that reason, a PGT-A should be offered to all patients over 35 years.

What are scratch and ERA Tests and are they effective?

At our clinic we have the Endometrial Receptivity Map (ER Map). This is a personalised test to diagnose the receptivity status of the endometrium during the window of implantation.

The ER Map test allows us to indicate the moment of the highest endometrial receptivity and, thanks to this knowledge, this increases the chance of successful implantation, pregnancy and increases IVF success rates.

To be exact the ER Map is the only endometrial receptivity test that includes an examination of the response of the genes linked to implantation.

This molecular tool is based on the expression analysis of 48 genes with functional relevance in the process of endometrial receptivity and the immunological response associated to embryo implantation.

3. Stress

Can stress cause implantation failure?

Stress never has a good influence on our body and health. Everything bad for our body is also bad for our fertility. That is the reason why a large amount of stress can have a big influence on the success of a pregnancy and fertility treatment.

There is also stress which is generated by undergoing fertility treatments and IVF.

In our fertility clinic, we think that it’s important to manage stress in three different steps.

1. First, it’s important to reduce the unpredictability of fertility treatments, so we provide transparent information about treatments, tests and about the entire fertility journey.
2. The second step is to personalise the treatment to the maximum level, and to go over our IVF success rates with the patients, also offering realistic expectations.
3. The third and last step is to offer our patients all the support and guidance they need.

4. Lifestyle

Can lifestyle changes prevent implantation failure?

The most recommended lifestyle is always a healthy one. The healthier our body, is the better it will receive fertility treatment. The best-known and easiest lifestyle changes are to quit smoking, eat a healthy diet, exercise regularly, and avoid stress if possible.

We know that infertility can push you into a roller-coaster of emotions. Feelings like guilt, shame, anger, helplessness, and unpredictability can become a constant stress source for every patient and must be avoided or at least relieved.

There are many different things patients can do to try to reduce their stress level and feel more comfortable during their treatment, like massages and acupuncture.

Finally, do you have any advice for TRB readers who might have experienced after repeated implantation failure?

In this case I would recommend PGT-A. Preimplantation Genetic Testing for aneuploidy, which helps to detect numerical anomalies.

It is a technique of pre-implantation genetic diagnosis to detect numerical chromosomal abnormalities in embryos. The normal number of chromosomes is 23 pairs, 22 plus the sexual pair: XX or XY. An example of numerical alterations would be Down’s Syndrome, in which chromosome number 21 appears tripled (trisomy 21).

This technique is mostly recommended for patients with a medical history that includes chromosomal problems, patients with low egg quality, and for patients with repeated implantation failures.

A big thank you to Dr Szlarb and the team at IVF Spain for giving us the low-down on implantation failure. For further questions, or to book in, connect with their team here.