What is implantation?
Implantation is when the embryo attaches to the uterine lining and begins to develop. It needs both a healthy embryo and a receptive lining. Repeated failure despite good embryos is distressing and calls for a systematic search for causes.
Causes
Embryo factors
Many embryos that look good under the microscope, especially at older maternal ages, have chromosomal abnormalities and fail to implant or miscarry early. Preimplantation genetic testing (PGT-A) may be considered for selected patients.
Uterine factors
- Polyps, submucosal fibroids or a septum
- Intrauterine adhesions (Asherman syndrome)
- Chronic endometritis
- A thin endometrium
- Hydrosalpinx (fluid in the tubes), which can be toxic to embryos
Other factors
Thyroid disorders, antiphospholipid syndrome, obesity and smoking can also affect implantation, and the role of sperm DNA damage is being studied.
Assessment and treatment
Assessment includes a review of previous treatments, hysteroscopy, ultrasound for hydrosalpinx and, when needed, chromosome analysis and hormone tests. Correcting a problem, such as removing a polyp or septum or blocking tubes with hydrosalpinx, can improve the chance of the next transfer. Many add-on treatments lack sufficient evidence and are not routinely recommended; the plan follows current evidence.
Frequently Asked Questions
After how many failed transfers should we investigate?
Does hysteroscopy improve IVF success?
Sources
The information on this website is for general information only and does not replace a medical consultation.
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