This is part two of our series on why IVF cycles fail after transfer.
Check out this playlist for part one and other really helpful videos
There are two categories of IVF failure: Problems with the embryo and problems with the carrier
On today's episode of InfertilityTV we will talk about problems with the carrier
A carrier is any woman that has an embryo placed into her uterus
The embryo could be from her own egg or another woman's egg doesn't matter
For today's discussion, we are going to assume that the embryo is perfect and normal.
Obviously this isn't always the case as we talked about in Part 1.
and yes, an IVF cycle can fail after transfer because of multiple problems with the
embryo and the carrier
First, let's talk about anatomic problems with the uterus
There are two categories of anatomic problems.
One type are those that a woman is born with.
The second type are uterine problems that are those that arise later, after birth.
Every woman who is going to attempt to conceive with IVF should have
some sort of uterine cavity evaluation before having an embryo transfer
This is extremely important!! Even women who have been pregnant before and have had a
normal delivery should still have a uterine cavity evaluation before
attempting an embryo transfer
Women who have not had a cavity evaluation for a long time
should also update one before an embryo transfer
There are several different methods for evaluating the uterine cavity
X-ray, ultrasound or directly with a telescope
This last method is called hysteroscopy
At IVF1, this is our favored method for uterine cavity evaluation
Most of the anatomic problems with the uterus can be fixed surgically-- but not all of them can
Sometimes, new problems can arise as a result of doing surgery on the uterus .
For example removing a mass from the uterus, such as a fibroid
could cause scar tissue to form inside the uterine cavity.
It is important to repeat a uterine cavity evaluation after any surgery to correct a problem
before proceeding with embryo transfer
One of the reasons that we like hysteroscopy to evaluate the uterus
is that it also allows us to look for other types of uterine problems
including endometritis.
Don't confuse this with endometriosis which is a different problem
Endometritis is when there is inflammation of the uterine lining
This is usually caused by bacteria and
can usually be treated with antibiotics
Let's talk a little bit more about the uterine lining.
In order for an embryo to implant, the uterine lining has to go
through some very important changes
The first change is that the lining gets thicker.
This occurs as a result of estrogen
The second change is more important
This is when the lining actually develops the ability to
allow an embryo to implant
In order for this to happen, a second hormone called progesterone is needed
Some women seem to have a problem where their uterine lining doesn't get very thick
even though there is plenty of estrogen around
There is plenty of science that shows that performing an embryo transfer
when the lining is thin will lessen the chances that an embryo will implant.
This problem is poorly understood and other than trying different types of estrogen
it doesn't have a good solution.
Doctors have tried a wide variety of other additives to help with this problem
but so far nothing seems to work consistently from patient to patient
or even in the same woman from one attempt to the next
It is an active area of research but right now nobody has an
answer for persistently thin uterine linings
Recently, doctors learned that changing the time of transfer
after the progesterone has started
can improve the chances for an embryo to implant.
Think of it this way, after a woman starts progesterone, the uterine lining starts changing
It takes a while for all the changes needed to allow an embryo to implant
Put an embryo in too soon or too late and even a normal embryo won't implant.
At IVF1, if a patient has had an IVF cycle fail after transfer,
we recommend a test called the Endometrial Receptivity Array or ERA
This test quantifies the changes that occur in the uterine lining and can
determine for an individual woman the optimal time for an embryo transfer
There are a few additional tests to evaluate the uterine lining that are in the pipeline
but they don't currently have enough evidence that they are accurate enough
and useful enough to start recommending just yet
But we hope to have some additional tools in the next few years
In the meantime, check out this playlist to learn more about additional tests available right now
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