What is EmbryoGlue? Should I use it for my IVF?

Embryo glue is a special medium that the embryos go into just before transfer – so at least 10 minutes. Basically what it does is a really high concentration of hyaluronic and some studies have shown that it increases the implantation of the embryos. There is a Cochrane review which is a combination of all good quality papers and that looks at whether it improves and found a slightly significant increase in life-birth rate, if you used embryo glue. Some studies have shown no difference so it very much needs further investigation.

Okay, so the embryo glue is a media that we use for embryo transfers; in this case, we have studies that say they were able to improve the rates. So it’s a more sticky media for the embryos that need to be implanted into the uterus. Yeah, I think it’s a good thing.

EmbryoGlue is not actually a glue. EmbryoGlue is a culture material that includes hyaluronan. Hyaluronan is a substance that naturally exists in the endometrium, and it has been proved that it helps in the attachment and invasion of the embryo inside it. The idea is to put embryos into this material before we transfer them inside the womb. In this way, we mimic the natural environment. According to some research, it has been shown that it increases the chances of implantation.
Is there any conclusive evidence behind it? Well, there is research that shows a small increase in clinical pregnancy rates. Most of the research shows that it is not statistically significant. So definitely, we need more randomized evidence behind it. It hasn’t been associated with an increase in the live birth rate.
But we can use it in a specific group of patients. This means patients that had unexplained failures before, with normal womb lining thickness, good quality embryos, and no other factors that could affect the implantation. It is a cheap product that only slightly adds to the cost of IVF. It hasn’t been associated with any risks. But I wouldn’t be using it in all IVF cases.

Embryo glue is kind of a medium which is effectively some fluid that is usually used to put the embryos in. The whole idea of embryo glue is a little bit more sticky because it has more of a chemical called hyaluronic acid. Embryo is hard to fall down and two, it may facilitate it sticking to the lining of the uterus. My personal views that this is insulting to intelligence because either the embryo has a life of its own which will make it move from a to b to c or even if you stable it will make no move whatsoever so the evidence is not great but unfortunately it’s heavily commercialised.

Embryo glue is a culture or cultivation medium. The fertilized eggs and the embryos are always in a cultivation medium that supports their development and growth. Embryo glue is used as a culture or cultivation medium for the day of the embryo transfer and it contains a high concentration of hyaluronic acid. The principle is that the embryos, thanks to this hyaluronic acid, should increase their implantation potential in the endometrium. So, we think it’s a good method that has an impact on IVF success.

Embryo glue is simply a solution that is supplied by a big IVF company called VitroLife, it is a culture medium that we used to culture embryos prior to the transfer. It is a rich blastocyst culture medium with a high concentration of a special ingredient that is called hyaluronan and human albumin as well. Why do many clinics choose to perform their embryo transfer using the embryo glue? Simply because studies have shown that it helps improve the implantation. It is a solution that is present in the human endometrium and studies have shown that it has a positive effect on implantation.

EmbryoGlue is a hyaluronic and albumin medium which is supposed to improve the chance of embryo implantation, so before the embryos are transferred to the patient, they are kept in a dish containing embryo glue. According to the
Human Fertilisation and Embryology Authority, embryo glue is rated amber – meaning that there is conflicting evidence from randomised controlled trials as to whether it is effective at improving the chances of having a baby for most fertility patients. So, further research is needed and until then its routine use cannot be recommended. Concerning its safety, EmbryoGlue does not carry any additional known risk for the patient or the child born.

EmbryoGlue is very new in IVF. At the moment, a lot of laboratories are looking into it. It is actually a medium that we use when we transfer the embryos. They stay there for some time. This medium usually contains a high concentration of proteins. It is a protein called albumin. It has been shown in some studies that if an embryo develops in this fluid culture, it creates a very thick sticky matrix that can help it attach better to the lining of the womb. So actually, it was a very clever idea.
Initially, we were very sceptical about how safe it could be for an embryo to stay in this medium before we transfer it into the uterus. The initial studies have shown that it is completely safe for the embryo, it doesn’t have any adverse effects. Now there is a lot of study going on whether it has some benefit or not.
Recently there was a study which, in medical terms, we call a Cochrane study. These are doctors who are gathering all the data from smaller studies related to this topic, and they are trying to see whether this helps or not. In general, it has been shown that it has no benefit in the success rates.
But there is a very small group of patients that it actually has shown some benefit in. These patients are usually 42 years old, and they had 2 IVF attempts with the implantation failure. They created good quality blastocysts that were not able to implant. In these patients, EmbryoGlue could have some benefit. For this reason, in our lab, we are considering to start using this technology. Our lab director is trying to find appropriate funds, so we can get this medium and start using it in a very well selected population of patients.
Unfortunately, this medium is a little expensive. It costs about 600 euros. You have to be very sure where to put it and whether you have a clear indication to put it. So we are looking into it. There could be a potential benefit for some people to use it. So the answer is: yes, we consider using it. However, only in a very well selected population group – not in all cases, as it hasn’t shown any clear benefit for all patients doing IVF.

Hyaluronan – containing mediums, like EmbryoGlue, are quite commonly applied in IVF procedures. These are physiological solutions containing hyaluronan, which is normally secreted in large quantities by the endometrial cells during the preimplantation phase.

Scientific research shows that more hyaluronan increases the viscosity of secretions, which makes them more adhesive. Thus, it stabilizes the interaction of the endometrium with the embryo, helping to implant the embryo into the endometrium.
EmbryoGlue, therefore, mimics the action of the uterine secretions from the pre-implantation period and makes the endometrium more receptive to embryo implantation, helping to initiate the process.

In addition to enhanced viscosity, hyaluronan acts as a medium between embryo and endometrium at the beginning of the implantation process by binding itself to specific receptors, mainly CD44. These are present in both: the embryo trophoblast cells and endometrium.

The application of EmbryoGlue during embryo transfer increases the success rate of IVF treatments. However, our findings show that significant differences are only observed when EmbryoGlue is used in the embryo transfer at the blastocyst stage, i.e. on the 5th or 6th day of the development. It is particularly advisable to use the medium in transfers of fresh and frozen blastocysts if the previous transfers failed and the women are over 35 years of age.