Answer from: Raúl Olivares, MD
The first thing that we must do is check if the embryo is of good quality because that can be very different depending on the patient’s age. If the patient is young, there is probably going to be a good correlation between morphology and genetics. Any embryo with good morphology should be considered to be of good quality.
If the patient is 42-43, most of the embryos that are going to look great, such as AA, AB, BA, can still have some genetic issues. When the embryos look great, and they don’t implant, the first thing to do is to take into account the age of the patient and check whether the embryos have been genetically tested, or not.
If you are sure that the embryos are of good quality either because the patient is young or the embryos have been genetically tested, then there could be issues on the endometrium side or the mother’s body. This could mean that the endometrium is not prepared for letting the embryo implant. The patient could have some problems related to coagulation, immunology, for example, antiphospholipid syndrome. It could happen that the endometrium’s environment is not the best because there is endometritis, chronic infection or even the endometrium microbiome may not be a perfect one. This is always going to make things more difficult for the embryos to implant.
In any case, the first thing that we need to do is to confirm that the embryos are of good quality. If they are, go and study the endometrium or the patient’s body to check if there is anything on her side that may be negatively impacting the outcome.
Answer from: Anna Voskuilen, MD
First of all, to answer this question, I think the more important thing is doing a little bit of introduction on fertility age. I always explain to patients that fertility is very dependent on the age of the patient. We know that we have a certain ovarian reserve that we’re born with. This ovarian reserve is going to decrease with age in terms of numbers, but also in terms of the quality of the eggs that we have. So actually, what we can test is the ovarian reserve, in terms of numbers, but not the quality of the eggs we have. And that’s why we are always talking about eggs and fertility.
What we do know is that for example, after the age of 35-37-40, it’s more difficult to achieve a pregnancy. We know that after 40, it’s trickier to become pregnant. There’s a higher risk of having a miscarriage. And also, there are higher rates of having embryos with problems in the chromosomes and all of this is related to the quality of the eggs which is then related to age.
The other thing that I want to say is, a good embryo in terms of morphology, isn’t necessarily related to the good genetics of the embryo. So we can see a very beautiful embryo, but this is not going to tell us if the embryo is a euploid embryo or not. Euploid embryo means that the embryo has the correct number of chromosomes and their good disposition. It is also a very important thing to know. When we talk about good embryos, we have to consideration morphology and also genetics which is very important. And the third thing is if we are transferring good quality eggs that have been tested and we know that they are euploid, they have the maximum possibility of implantation when we are using euploid embryos, we know that the success rate is 70% more or less. So we know that not all of them will implant and this can be because of statistics. We know that not all of them will implant. We would like to give a 100%, but it doesn’t work like this.
On the other hand, if we have several implantation failures, then we need to check if there’s something else that is affecting it. Because the first thing that we have to check is if the embryo is correct in terms of genetics and also that the karyotype of the parents that are giving the eggs and spermatozoid is correct. But if this is confirmed and still doesn’t work, we have to rule out, e.g. thrombophilia factor, a predisposition of having blood clots and problems to become pregnant, or repeated miscarriages. We have to study the uterus to make sure that everything is correct with the hysteroscopy or biopsy. We can also study the endometrium to see if there’s a problem with the receptivity of the endometrium or, or we can also test microbiota. And also we can test some immunological things that would be responsible for this bad outcome.
What are the reasons for IVF failure when good quality embryos were transferred?
Even embryos that are of good quality may have some defects, which cause failed implantation. Can you get pregnant with such embryos though? Why does IVF fail with perfect embryos? Why do euploid embryos fail to implant?