What to do after IVF failure?
The In vitro fertilization process can be emotionally, physically, and mentally exhausting. You finally take the plunge and make the decision to pursue IVF to build your family, and then these incredible embryos you make don’t implant after the transfer. A failed embryo transfer can be devastating.
Recurrent implantation failure (often defined as failure to achieve a clinical pregnancy after two or more embryo transfers of morphologically good embryos) is estimated to affect approximately 10% of women seeking IVF treatment.
At CCRH we recognize the frustration and disappointment with failed embryo transfers. We are constantly reviewing the most up to date technology and validated diagnostic testing that can improve your chances of a successful transfer.
We will review some of them in this article.
Diagnostic tests for failed embryo transfer
ERA (Endometrial Receptivity Analysis)
What does the ERA test look for?
The preparation of the uterine lining is crucial for implantation to occur. While preparation with estrogen and progesterone is the gold standard, every woman has a specific window of implantation (where the lining is receptive or “sticky” to an embryo trying to implant). About 3 in 10 women have a displaced window of implantation. This adjustment in progesterone timing can make all the difference in having a successful transfer.
Who should undergo ERA testing?
We offer patients who have had two failed embryo transfers of morphologically good embryos, or a single failed transfer with a euploid embryo the option of pursuing ERA testing. There is some data that show the pregnancy rate using ERA even with the first IVF cycle can result in a higher pregnancy rate.
How does ERA work?
After a consultation with Dr. Mor or Dr. Woo, if we believe you are a good candidate for additional ERA testing we will start a mock transfer cycle. You will be started on estrogen and progesterone preparation based on the standard protocol, and instead of an embryo transfer, on that day we perform a uterine biopsy in the clinic. The result will show that the lining is receptive ( the transfer is occurring during the window of implantation) or non- receptive (your window of implantation is displaced). If you have a non-receptive result that will guide us to adjust and personalize your embryo transfer.
ReceptivaDx
What does ReceptivaDx look for?
ReceptivaDx is a test that detects inflammation of the uterine lining most commonly associated with endometriosis, one of the leading causes of infertility and failed implantation.
Who should undergo ReceptivaDx testing?
Women with unexplained infertility with previous failed embryo transfers of high quality embryos should consider ReceptivaDx testing.
Women testing positive for ReceptivaDx ( BCL6) are 5 times less likely to succeed in IVF than women testing negative.
How does ReceptivaDx work?
Similar to the ERA, the ReceptivaDx can be done during a mock cycle with an in clinic uterine biopsy or it can be timed to your natural cycle.
What happens if I am positive for ReceptivaDx?
If found to be positive for BCL6, endometriosis is likely. A treatment plan involving hormone therapy or laparoscopy to remove visible endometriosis can correct the situation. Dr. Mor and Dr. Woo will walk you through the risks and benefits of both and help you choose the best treatment option.
Endometritis
Endometritis is an inflammatory condition of the lining of the uterus. Endometritis is generally caused by infections, sexually transmitted infections such as chlamydia and gonorrhea may cause it but so can the normal mixture of vaginal bacteria.
While some women may have abnormal vaginal discharge, or vaginal bleeding, others may have no symptoms. Inflammation in the uterine lining though can lead to infertility and failed embryo transfer.
Who should be evaluated for endometritis?
Women with unexplained infertility with previous failed transfers of high quality embryos should consider endometritis testing. Women with history of pelvic infections, surgical procedures of the uterus, or recent miscarriage may also benefit from testing.
How does Endometritis testing work?
Biopsy for endometritis can be done in the clinic as part of a mock cycle or timed to your natural cycle.
The pathologist will evaluate the biopsied tissue for any inflammatory cells (plasma cells) that are a sign of infection.
What happens if I do have endometritis?
Treatment for endometritis is a course of antibiotics. Rebiopsy of the lining to show a test of cure (endometritis is resolved) is important prior to proceeding with the next transfer. There is convincing data that shows a higher chance of a successful transfer after endometritis has been cleared.
Dr. Mor and Dr. Woo are prepared to provide a second opinion for you if you have suffered multiple IVF failure. After a thorough evaluation of your individual situation, we may advise additional testing and treatment options to help you have the best chance at success.
References:
*Simón et al., In vitro fertilization with personalized blastocyst transfer versus frozen or fresh blastocyst transfer: a multicenter, randomized clinical trial. Fertility and Sterility, 2019; 112. e56-e57. 10.1016/j.fertnstert.2019.07.273.**Oral presentation, Clemente-Císcar, ESRHE 2018
Likes CE et al. Medical or surgical treatment before embryo transfer improves outcomes in women with abnormal endometrial BCL6expression. J of Assist Reprod and Genetics, 2019; 36. 483-490.
