Constantino Dino Demetroulis, MD
Director at Biogenetic Center for Human Reproduction, Biogenetic Center for Human Reproduction
Category:
Embryo Implantation, Embryo Transfer, Failed IVF Cycles, Success Rates
A baby for every couple.
On average, the embryo is circa 60-80% responsible for implantation, with the endometrium counting for around 20-40%.Whilst this figure is indeed less, it is still a major determinant in providing a successful outcome following IVF. It is therefore imperative that the body is properly prepared and that the procedure is performed correctly.
The three greatest factors, which are known to affect pregnancy rates, are the embryo quality, uterine receptivity and transfer efficiency.However, within these determinants are numerous variables which can either have a positive or negative effect on the outcome. These include; the day of transfer, the transfer medium, catheter choice and placing of the embryo/s in the uterine cavity; all aspects heavily linked to the transfer process.
Endometrium comes from the Greek words Endo (inside) and Metra (uterus), it is the host of the embryo and the place where life grows, develops and lives until birth.During pregnancy, the glands and blood vessels, in the uterine lining, grow, increasing in size and number. Vascular spaces fuse, becoming interconnected and forming the placenta which, once a pregnancy is fully established, supplies oxygen and nutrition to the baby. Implantation does not just happen at any time during a woman’s menstrual cycle, it can only take place during a specific timeframe, which is medically referred to as the window of implantation. During this window, the uterus is at maximum receptivity. To establish an endometrium which is optimal to receive and accept an embryo, several specific determinants, such as hormonal or immunological factors, need to coincide.
Endometrial thickness also plays a role in helping to achieve a successful pregnancy outcome.Dr Demetroulis explains that a woman’s uterine lining should be between 8-12mm, advising that thickness improves blood flow to the uterus whilst also providing a suitable place for the embryo to implant. With IVF one approach does not suit all and it is the same when preparing the uterus; the endometrium is complicated. Within the body there are around 20,000 protein coding genes, which are expressed in human cells, circa 70% of these are found within a normal endometrium, finding one treatment to fit everyone is impossible. Doctors must ensure they have fully investigated the patient’s medical history, looking at what previously went wrong and trying differing regimens to find the most optimal treatment protocol for everyone. When preparing for an embryo transfer it is important that the female is regularly scanned. Conditions such as OHSS, endometrium polyps, uterine fibroids or a thin endometrium can all have an adverse effect on implantation. For patients suffering from any of these issues, then a freeze all cycle may be the most beneficial option. In women who have suffered from recurrent implantation failure then medical teams might also want to check for hydrosalpinges. This is when the fallopian tube/s become inflated with water. If the fluid passes down into the uterus it has the potential to affect the embryo. Fallopian tubes can be drained of any liquid which could hinder implantation.
Doctors should discuss all available options with their clients who, in turn, must never be afraid to ask any questions or challenge medical teams. The aim of every fertility specialist is ultimately to make every couple happy, and they should never be offended by patients who question.
From his own experience, Dr Demetroulis has seen successful pregnancy outcomes from lower quality embryos, advising that chances are chances, percentages are merely a number and it’s the pregnancy test which tells patients whether they have been successful, not the statistics.You may also be interested in reading: How to prepare for IVF Embryo Transfer, before and afterwards – Patient’s perspective
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