Free IVF Magazine 2022.
Download and read articles by top IVF experts worldwide.
Download and read articles by top IVF experts worldwide.
Roksolana Semchyshyn, MD, PhD
Head of IVF department at Intersono, Intersono IVF Clinic
Category:
Embryo Implantation, Embryo Transfer, Failed IVF Cycles, Success Rates
In this webinar Dr Roksolana Semchyshyn, a fertility doctor and head of the IVF department at Intersono clinic, Ukraine, explains the importance of a healthy endometrium, outlining the window of implantation and describing what happens after an embryo is transferred.Before explaining why the uterine lining is so important, Dr Semchyshyn advises that patients need to understand the process of implantation, and how the partnership between the endometrium and the embryo works. Following the fertilisation procedures of IVF, an embryo is transferred into the female’s uterine cavity. Implantation does not take place immediately and, once in utero, an embryo will start searching for the right place to implant. As it does, it transmits signals which the endometrium reads and then uses to understand whether, or not, the embryo is good enough to implant. However, this all-important communication, between the embryo and the uterine lining, will only take place if the endometrium is healthy and has a normal structure. For any embryos permitted to implant, that usually happens around four to five days after the transfer.
The main function of the endometrium is to provide the most suitable conditions for an embryo to implant. Abnormal inclusions, such as polyps, can be a factor of unsuccessful implantation, as can IVF itself.Due to the medically induced suppression of the endometrium during the down regulation process, a woman’s body is sometimes unable to read the signals emitting from the embryo. In order to check whether the endometrium is fully healthy to receive the embryo, regular ultrasounds are crucial. Screening is also imperative to check on the thickness of the uterine lining in advance of the transfer. Dr Semchyshyn advises that an appropriate measurement of the endometrium is essential for increasing the chances of pregnancy. For an embryo to implant properly it needs enough space to embed into the endometrial lining. If this lining is too thin there will be a decreased blood flow to the uterus and the embryo may not be able to implant correctly. On the other hand, if the lining is too thick this could make it more difficult for the embryo, and could also lead to hyperplasia; a continued, abnormal growth of the endometrium.
According to Dr Semchyshyn a lining which measures between 8-14mm is ideal or, when undergoing a cryo (frozen) cycle, from 7mm.For women who have repeatedly failed to become pregnant, following the transfer of healthy embryos, a hysteroscopy may be recommended. In this procedure a camera is used, in utero, enabling medical teams to see the uterine cavity more clearly than on an ultrasound. Intersono clinic has noticed a higher pregnancy rate in patients who undergo this procedure, however, there is no evidence that it is a benefit for all patients undergoing IVF, and hysteroscopies should not be routinely advised for everyone.
Whether conceiving naturally or by IVF the window of implantation is critical for a successful pregnancy.Every woman is different but, on average, this window typically takes place around day 20-24 of a woman’s cycle, which is circa 6-8 days after ovulation. It lasts for 48 hours. In IVF, the window of implantation is effectively the timeframe when embryos need to be transferred into the uterus; it’s when the endometrium is at its most responsive.
If IVF with good quality embryos has been unsuccessful then an ERA (Endo Receptive Array) test may be recommended. An ERA is used to detect when the endometrium is at its most receptive.By conducting this type of biopsy, medical teams are able to look at the genes responsible for implantation, determining when they are at their most active. This will then tell doctors when the transfer should take place.
For a woman to conceive her body needs to be “baby friendly” which, in part, means having good immunological health. Dr Semchyshyn describes the body’s immune system as the “bodyguard of our organisms,” and advises that clinics should run immune testing on female patients who have suffered repeated IVF failure or recurrent miscarriage.
“Unexplained fertility generally means that the physician failed to find the true cause of infertility” said Dr Norbert Gleicher and Dr Semchyshyn agrees..Greater reproductive knowledge is continually amassed, and further testing and analysis can now be carried out to help couples find out exactly why they are struggling to conceive. With correct clinical procedures and medical guidance, patients should be offered a diverse range of protocols to prepare for individualised embryo transfers, most suited to their particular needs. Medical teams have a duty to patients to be thorough in their screenings, recommending specialised regimens based on medical and fertility treatment history, alongside current, comprehensive test results. When it comes to preparing the endometrium, regular and detailed ultrasound and hormonal monitoring are absolutely key. Combine a good quality embryo with a healthy endometrium and immune system, and the probability of successful implantation leading to a healthy pregnancy and live birth is greatly improved.
Disclaimer:
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Contact details: The European Fertility Society C.I.C., 2 Lambseth Street, Eye, England, IP23 7AGAnalytical cookies are used to understand how visitors interact with the website. These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc.
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