Homepage Improve your chances for embryo implantation
Category: Diagnoses, Fertility TreatmentsJune 14, 2008 6:00 pm
Here are the factors that affect embryo implantation:1. oocyte (egg) quality
Implantation is more likely to occur when a healthy embryo is present, and the best predictor for a healthy embryo is a healthy egg. Egg quality comes from a number of factors.2. sperm quality
We now know that paternally imprinted DNA is disproportionately expressed in developing placental tissue. In other words, sperm quality matters a lot when it comes to implantation. For a successful pregnancy, sperm should have stable, well balanced DNA.What you can do:
There are many ways that sperm quality can be maximized. Antioxidant vitamins are a popular intervention.3. Embryo quality
Embryo quality is a reflection of both egg and sperm.If you are doing an IVF cycle, embryo quality can be determined by grading systems. The embryos most likely to continue to develop will have 6, 7, or 8 cells by day 3 of development in the lab.
If you are considering a frozen embryo transfer (FET), embryo quality is also a reflection on the laboratory’s freezing-and-thawing success rates. In general, FET cycles have a pregnancy rate of one-quarter to one-half that of fresh cycles, but the rates vary by clinic. Embryos may be frozen with the traditional slow-freeze protocols, or with the new, flash-freeze vitrification methods. There is still some debate as to which is better.
What you can do:
Maximize egg and sperm quality before you start treatments.
Consider a repeat fresh IVF cycle instead of multiple frozen cycles.
4. The number of embryos transferred
There are some suggestions that embryos help each other to implant. In other words, the more embryos that you transfer, the greater the chance that each one will stick
What you can do
Be very careful with this one. The movement in our field is away from multiple-embryo-transfer, not towards it, because the risks associated with multiple pregnancy are very real. Some clinics even advocate for elective single embryo transfer.
But if there are other impediments to implantation -say, embryo quality is a known concern- then our standard of care is to transfer multiple embryos in the hope that one will take.
5. The woman’s overall health
Tests commonly ordered as part of the overall health screen include thyroid function and prolactin levels.Depending on your situation and family history, you may also be screened for other systemic diseases that can affect implantation. For example, we might look to rule out diabetes, autoimmune conditions such as elevated Natural Killer cells, a pre-disposition to hypercoagulability, markers for celiac disease….and many more.
If you and your immediate family are otherwise healthy, many of these tests are not routinely offered.
What you can do:
Eat well, exercise moderately, don’t smoke, and continue seeing your family doctor for annual checkups even when under active fertility care.If you have or suspect a specific medical condition, ask your doctor if further testing is warranted.
6. Shape of the uterus and fallopian tubes
Some women have an anterverted uterus, some women have a retroverted uterus. Both are fine: the terms simply refer to which direction your uterus tips. Of more importance, we need to confirm that the uterine cavity is a normal size and shape for implantation to be successful.
To confirm the structure of your uterine cavity, the gold standard of imaging is a 3-dimensional sonohysterogram. Hysteroscopy (surgery) may also be suggested when necessary. Indications for hysteroscopy include fundal polyps, impinging or submucosal fibroids, and/or a uterine septum extends 10mm or more.
The shape of your fallopian tubes should be confirmed by ultrasound, a hysterosalpingram, or (less often) surgery. I also screen for chlamydial antibodies, as a history of this infection can affect tubes. We know that dilated tubes (”hydrosalpinges”) may compromise implantation, and we sometimes suggest that they be surgically removed before IVF.
What you can do:
Make sure that you have had all the imaging tests available to you updated before starting your treatments.If your doctor suggests uterine surgery, a second opinion may be warranted. But don’t be too hesitant: the surgery is often a day procedure, and the benefits can be profound.
7. Lining of the uterus
We look at the uterine lining itself, to judge whether or not implantation may be expected. The endometrial lining can be assessed in the following ways:Appearance on transvaginal ultrasound
An ideal lining will be at least 7mm thick on day of ovulation trigger (HCG).Ideally, it will also have a “triple line” appearance (an ultrasound finding that denotes a good response to estrogen).
After ovulation, the endometrium compresses somewhat, and the triple-line pattern will be less distinct. These are normal findings.
Luteal endometrial biopsy
An endometrial biopsy is not part of every cycle, but it may be done in the luteal phase of a cycle before IVF, in an effort to confirm that the implantation window exists.
This “window” describes the idea that the lining itself is only receptive to embryo implantation for a short period of time. Various markers for this implantation window have been identified, including histologic appearance & grading, specific findings seen only by electron microscopy, and the staining for various markers that are thought to be associated with implantation.
Probably the best tests for the markers of implantation are being run by Dr Harvey Kliman, associated with Yale. He calls his set of tests the “Endometrial Function Test (EFT)”. I offer the EFT through my office in partnership with Dr Kliman.
But even the EFT is less than ideal. We simply do not know what all the markers are for implantation. This causes great frustration for patients and clinicians alike, for sometimes we suspect a small, or even absent, implantation window yet cannot prove it. In the end, the EFT alone cannot predict implantation failure or success with 100% certainty.
What you can do:
When endometrial thickness is concerning low (the lining is never more than 6mm thick), you should talk to your fertility doctor, for management is highly individualized. Many authorities recommend a BMI of >18.5; a healthy lifestyle that involves no smoking and limited caffeine; and ask that you consider red meat to be part of your diet. Supplemental estrogen is regularly used and acupuncture may also be suggested. But as I said: you should really speak with your doctor.If you have irregular cycles and a tendency towards a thick lining (>12mm), you might benefit from an endometrial biopsy to rule out hyperplasia.
Even if the EFT is limited, the very act of getting an endometrial biopsy may help with implantion. The proper studies have not yet been done to support this statement, but many smaller ones suggest that implantation may be boosted by as much as 20% in some cases. For more, see this Globe & Mail article.
8. Embryo transfer technique during IVF
In an IVF cycle, embryo(s) selected for transfer will be collected into about 0.020cc of fluid and inserted into the womb. The process of insertion is highly physician dependent: this means that it matters who does your embryo transfer. The following issues will be considered by your doctor:(a) Transfer medications like progesterone, antibiotics, and steroids.
(b) Cervical preparation
(c) Use of a tenaculum
(d) Catheter type
(e) Ultrasound guidance
(f) Post transfer instructionsWhat you can do:
Work with a doctor, and a clinic that you trust implicitly. Embryo transfer is very important. Some physicians suggest a mock transfer prior to the IVF cycle itself. It has been my experience that the uterus is lying in a slightly different position every time. In other words, the mock transfer did not help as much as I would have hoped for. I now judge the value of a mock transfer on a case-by-base basis.9. Luteal Support
We support the luteal (post ovulatory) uterine lining with progesterone whenever we are worried about natural progesterone levels. Progesterone may be taken orally, intramuscularly, vaginally, or rectally.
Other medications that you may read about for the luteal phase, and into early pregnancy, include estrogen, ASA, dexamethasone, Fragmin, Lovenox, IVIG, HCG, and others. We are very cautious here: some of these medications have side effects that, in some circumstances, could be of real concern to you 0r your baby.
What you can do:
Talk to your doctor. The medications that you take in the luteal phase, and into pregnancy, must be compatible with bringing a healthy child into this world. That said, the ideal balance will keep your endometrial lining stable. If you find that you consistently have your period before the planned pregnancy test day, your luteal support may need to be re-examined.
10. Lifestyle
You need to minimize caffeine, quit smoking, and avoid alcohol. Intercourse during the “two week wait”? I believe it to be fine, but I would ask your doctor, as everyone has a different opinion on this subject.
Conclusions
To be successful, your clinic must focus on implantation. Many protocols and techniques are well standardized across fertility clinics, but implantation standards are not. Consequently, there remain great differences in implantation rates between clinics, and between doctors.
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Tanya
Hello Dr
I have a quick a question for you, I had my first fresh IVF cycle April 2008 and got pregnant with triplets unfortunately due to incompetent cervix I lost my pregnancy at 20 weeks
My age is 29 yrs and reason for IVF was Male factor (Azoospermia) I am now planning for an FET as I have 11 frozen embryos 3 from my husband graded as 7 cell, 8 cell and 10 cell and 8 from the donor sperm graded 10 cell,9 cell, 8 cell and 7 cell
Please advise if I should do an FET or look at a fresh cycle again. My clinic stated that the anything which is 4 cell and above after thawing will be considered for transferring. I need help and advise both
TGH replies:
Hi Tanya,
such a difficult story. I will try to help here:
Day 3 embryos are often categorized with a cell count (usually 6,7, or 8 cells is best) and a grade (a 5 point scale…for some clinics, “1″ is the best, others “5″). I would expect that you will have a good number of high quality embryos to choose from.
As you know, FET rates are rarely comparable to fresh cycles. But they are also *much* easier to go through with fewer injections, fewer side effects, and of course, less expense.
All things being equal, I would certainly try one FET cycle if your clinic agrees.
Here are two important decisions, however, that I cannot help you with through this forum:
1. How many embryos to transfer (you should speak with your doctor)
2. Transferring embryos fertilized by your partner vs donor (a counsellor can be of benefit here)
Tanya, I would hope and expect that you will become pregnant again. Hopefully with your next cycle, but as we cannot know for sure, I would suggest that you might consider FET attempt, and then, reassess your options again.
And when you do become pregnant, make sure that your care is transferred early to an Obstetrician so that your cervical length can be followed closely.
I wish the best for you
nat
Hi Dr.,
I am concerned about the quality of my menstrual blood. It has been very different in consistency in the last 2 years, which i find alarming. Namely it is very red, quite thin (like water, not so thick and gooey) and has clots in it. I am 38 and undergoing fertility treatments, and a “poor responder” but have gotten my embryos to blast, and they’ve been graded A- A+. I am beginning to wonder of these changes in menstrual flow is literally due to “poor” eggs. no one seems to know what I am talking about!
Any thoughts?
natgutt@att.net
TGH
Nat,
I, too, don’t have much to say on the qualities of menstrual flow. However, some alternative health care practitioners certainly will, especially those versed in Traditional Chinese Medicine.
I would therefore suggest asking an acupuncture caregiver with a special interest in fertility.
Liane
Hi Dr. Hannam,
Part of my current fertility treatment includes dexamethasone taken daily, I was told that this was necessary due to high levels of 17-OHP (6.3 nmol/L in my investigative cycle). The dexamethasone has lowered this level since then. However I was told that I would have to continue taking the dexamethasone even when I get pregnant. Why is this, and what role does 17-OHP play in fertility? I also had high levels of cortisol (748.4 nmol/L) is this related in anyway?
Thanks
Lee
Hi Dr. Hannam,
I was wondering if you could help explain the role of 17-OHP in fertility? During my investigative cycle I was told that I have high levels of 17-OHP and high levels of cortisol, are the two related? Could these high levels contribute to my prememstral spotting? Part of my current fertility treatment includes dexamethasone taked daily, how does this help and why would it be necessary for me to continue taking this when I get pregnant?
TGH
Dear Liane, Lee,
17-OHP and cortisol are circulating hormones found in all women. In general, any hormone that is found to be markedly outside of the normal range may have the potential to impact fertility, often by affecting the regularity of the menstrual cycles.
It is for this reason that we often look at 17-OHP in women with irregular cycles.
Will the dexamthasone help you? Must you take it during pregnancy? My generic advice, when it comes to taking steroid supplments like dexamethasone, is to proceed with caution and look to a second opinion if necessary. For example, your doctor might be able to refer you to an “Antenatal Assessment Unit” where you could ask the Obstetricians their views on dexamethasone during pregnancy for your particular situation.
Dexamthasone therapy is not a routine practice across all fertility clinics.
dove
Hi Dr. Hannam,
I have done 2 failed ivfs and i fet where I had a chemical pregnancy. In my ivf cycles my estrogen was close to 30,000 both times. My body for some reason tolerates it and I do not develop OHHS, however I have been told that fresh cycles are not good for me and that maybe the estrogen makes the enviroment inhospitable for the embryo. I have 10 blasts on ice, my clinic has told me frozen cycles are almost as successful as fresh, but your site says that’s not true. Just wondering what you think re: estrogen causing a bad environment and frozens being a better option for me. We are unexplained, produce lots of eggs, but it never seems to take.
TGH replies:
Hi Dove,
You are right, in my experience, frozen embryo transfer (FET) cycles are not as successful as fresh. However, rates can vary from clinic to clinic; perhaps your team has frozen rates that are comparable to fresh.
There are some theoretical advantages to frozen cycles: hormone levels can be much more physiologic ie in the normal range. A normal peak estrogen is only 1000 pmol/l; it may be that the very high levels associated with fresh IVF affect implantation in your case.
With 10 frozen blastocysts, once all basic screening tests are done (a sonohysterogram for example, and a hormone screen), it may well be prudent to try a FET. FET cycle protocols are notable for a minimum of hormonal intervention; sometimes we use no medications at all.
With estrogen levels of 30000 and 10 frozen blastocysts, you are certainly a high responder. Such scenarios are often associated with better than average pregnancy rates; I hope that you can find success soon.
Dixa
I would like to know your feelings about Metformin. I was diagnosed with pcos about 2 years ago when I first tried to get pregnant. I have had several IUI’s resulting in one chemical pregnancy and one blighted ovum. I am about to try an IVF but I am worried about continuing to take Metformin.
Thank you,
Dixa
TGH replies:
Dear Dixa,
In recent years, we have been encouraging many patients to take metformin when they have been diagnosed with polycystic ovary syndrome (PCOS). The idea was that many women with PCOS can have difficulties with insulin and insulin-like hormones; metformin helps to regulate insulin. The hope was that such regulation would help to yield more ongoing pregnancies for PCOS patients.
I still suggest metformin for women who are at risk for diabetes. But the latest consensus statements suggest that metformin may not be as helpful as we thought it was for patients who have good natural glucose and insulin control.
Dixa, the list of complications associated with metformin is short. It is, in general, a very safe medication. But it would be reasonable to ask your clinical team to reconsider, given these new guidelines, if the medication is still necessary for you.
Theresa
Dear Dr. Hannan,
My husband and I have tried to conceive at our Toronto fertility clinic for the past 3 years. We were married 5 years ago. I became naturally pregnant once during that time. My husband has very low sperm count. I have a 5 cm fibroid, which my RE is encouraging me to remove. However, in my previous marriage, I got pregnant easily 3 times, with that fibroid, which sits on the outside of the uterus on the fundus, although it was then 3 cm. I don’t want this major surgery unless absolutely necessary. We have tried IUI, IVF, and finally donor eggs and ICSI, as I am in my mid forties. The donor cycle with ICSI created excellent quality 3 day embryos. We were so hopeful. But after 6 embryos were implanted, 2 at a time, they were all failed transfers. After my natural pregnancy, which ended in a blighted ovum removed by D&C, I had endometritis. There may be some scar tissue from this preventing implantation. We have 4 embryos left, frozen at our clinic. I am still ovulating almost every month and have a very regular cycle. I am thinking that maybe we should try some more to conceive naturally, since this is the only way I have become pregnant to date. Please be so kind to help me and let me know what you think I should do now to maximize my chances of pregnancy.
Thank you very much for your consideration,
Theresa
TGH Replies:
Dear Theresa,
I know of a woman who conceived and delivered a healthy baby, naturally, at age 51. I know several at age 47y. To be fair, they are very infrequent occurrences, but it is understandable on many levels how appealing this approach would be for you.
But you mention that there is now severe male factor, whereas in your past this was not the case. I would hope and expect that you and your current partner did, already, try naturally many times before and between treatment cycles…so by history alone, it would seem that fertility treatments are going to be necessary to help you to conceive.
So you are looking at IVF and, reasonably, chose the route of donor eggs. This again makes sense, for women >42y can have a frustrating low chance for success on any given IVF cycle, whereas donor eggs are meant to elevate your success rates higher, to 50, 60, even 80% per cycle depending on the clinic and other circumstances.
So you’ve done everything right so far.
Endometritis
An infection can cause scarring and inflammation of the lining. The scarring can be ruled out by hysteroscopy (day surgery) and the inflammation through a biopsy. Probably the best biopsy analyses are done by Dr Harvery Kliman at Yale. Your clinic can send the biopsy specimen to him. You can learn more about this test here.
Fibroids
You conceived before, but, unfortunately, fibroids can grow over time. That said, you are right to be unsettled: we all suggest fibroids that impinge on the cavity be excised, but when they are on the outside, you will find disagreement between practitioners. Five centimeters is still not large. A second opinion on this point is not unreasonable.
The embryos
Embryos can be of seemingly high quality on day 3, but grow less well over time. To help rule out a negative contribution from the sperm, you might ask that the remaining embryos be grown out to the blastocyst (day 5) stage before transfer. Another idea before any future fresh cycles: confirm his fertility potential with a sperm DNA integrity test
Summary
Theresa, your way forward isn’t clear at this point. Donor eggs turned out not to be the quick-and-easy solution for you. My above solutions -hysteroscopy, biopsy, more tests- are not easy either. If you feel you might be at a cross roads right now, I would suggest counselling. Going back to trying naturally may well be the answer to a happy life and marriage, but, it is unlikely to result in pregnancy. Counselling might help you decide if it the right choice for you anyways.
Best,
Tom Hannam
Dahlia
Dear Dr Tom,
Thank you for the valuable information you provide on this forum.
I am age 39 and just starting to research fertility treatment options.
When I was 22, I underwent laser cone surgery for cervical cancer (no reoccurrence since). In March ‘09 I was diagnosed with a 12mm hemorrhagic cyst on my right ovary. I have a follow up ultrasound scheduled for this week (April 23/09).
Given my age and history, and assuming my husband’s sperm are healthy, will I be a candidate for IUI? I had a laparoscopy (and D&C and blue dye) in October 2008 which indicated functioning tubes and no evidence of Endo. My cycles are always 28 days. I can feel my right ovary on Day 13 and consistently experience bleeding at this time in my cycle, particularly following intercourse.
Dahlia
TGH Replies
Dahlia,
With reason to suspect a cervical factor (due to LEEP) and no other compromises identified, you are an ideal candidate for up to three IUI attempts.
Bhuvana
Hello Doctor,
I had my 3rd IVF - ICSI this month. Everything went on well but I got my period one week after transfer (embryo was transferred after on 5th day).
I’m not sure what to do?
Please advise me.
Thanking you
Bhuvana
TGH replies
Dear Bhuvana
I am sorry to hear that your menses came early…before the end of the ‘two week wait’. In my practice, we use both progesterone and estrogen support during this time. Since I added estrogen to our luteal support protocol, I cannot recall the last time I saw early menses.
carmilla
I had frozen embryo transfer on June 2nd and on June 11th I have had a little pink spotting. Should I be worried?
TGH replies:
If you call the clinic, they might tell you that a little spotting could be an “implanation bleed”. In all honesty we have no idea why some women spot a little bit; but if it only lasts a day or two, and is barely noticable (pink or brown), it does not seem to matter or affect prognosis.
Success rates from FET cycles are in the 15-40% range for most clinics. I hope that you prove to have a successful cycle.
Leonie Els
Brilliant!
Oli
Dear Dr Hannam,
I have found your articles very interesting. I was wondering if you would have any suggestions for our issues.
I am 38, my husband 39. We had several IUIs back in 2007 and I had a laparoscopy in 2007 to treat some minor endometriosis, my tubes were also checked and were fine.
We had our 1. IVF /ICSI in May 2008. From 14 eggs 12 fertilised, and 7 reached blastocyst level, one hatching blastocyst was transferred. It did not implant. Before FET I had some additional tests done and was diagnosed with Hashimoto. I now take thyroxin (100) 6 times a week. All together I had 5 FETs, only one embryo failed to thaw.
We had our 2. IVF/ICSI in May 2009 and today I have again found that my test was negative. This time we had 9 eggs, 8 fertilised, one was transferred and 5 frozen. All of them blastocyst.
I fear the problem is not with the embryos but rather with me. Apart from thyroxine and folic acid I do not take any other medication. We are both non smoker and otherwise healthy.
Please advise.
Thank you
TGH replies
Dear Oli,
When a couple consistently makes many blastocysts -as you and your partner do- it almost always implies good embryo quality.
That said, there are two issues with your transfers to date:
1. You have been doing elective single embryo transfer. eSET has the laudable goal of minimizing risks for multiples, but it comes with a reduced pregnancy rate per transfer. Any given blastocyst only has a 50%ch for being genetically viable.
2. Frozen embryo transfer cycles, in many programs, don’t have a very high success rate when compared to fresh cycles.
This means that, in your case, you may still, after all this time, still have a good chance for pregnancy.
My advice:
1. Ensure your testing is up to date (3D sono or hysteroscopy, autoimmune, coagulation, hormonal, and genetic screening).
2. Ask for counselling around preimplanation genetic screening for embryos (I don’t usually advise PGS, but this might be the right time to get as much information as possible).
3. Ask about the endometrial biopsy that can be done on the cycle prior to transfer.
4. Consider transferring at least 2 fresh blastocysts. If you do an FET cycle, assuming you can handle the uncertainties (medical, moral) of selective reduction, transfer at least three.
Because if your next fresh transfer doesn’t work, you may seriously have to consider gestational carrier.
So many variables to consider! I really cannot offer a complete second opinion in this forum. But I hope these comments are enough to get you started.
Tom Hannam
Dahlia
Dr Tom,
I am scheduled for an Echovist HyCoSy test as part of my fertility diagnostic process. I have serious concerns about the pain I will experience during the procedure given the scar tissue on my cervix from a laser cone. (A regular pap test is painful; a colposcopy is almost unbearable.) I am wondering whether it will even be possible for the doctor to insert the catheter. In your experience, what percentage of your patients with some degree of cervical stenosis have successfully undergone this procedure? How was the pain managed during dilation? Would you agree that it is necessary for me to have this test even though I underwent a laparoscopy 9 months ago and my tubes were clear then?
Thanks,
Dahlia
TGH replies,
Dahlia, I cannot really comment on the necessity of the test. But I can say unequivocally: no procedure should hurt. With modern anaesthesia, there really is no excuse for it. For example, in your case, you could ask about misoprostol (to soften the cervix), Ativan (for you), and a local-freezing-spray for your cervix. The procedure itself should never stand in the way of your desire to become pregnant. Hope that helps.
Darma
Dr. Hannam:
I went to see a fertility clinic and they said that they found mycoplasma/ureaplasma in the culture - my husband and I took antibiotics for 28 days and had to use a condom and the following month, I have to have an endometrial biopsy and sperm analysis for my husband to see if it is gone. We were told to continue to use a condom until the results come. I have tried to look up information regarding this organism and there isn’t anything definitive, and that there isn’t anything concrete out there to confirm that it negatively affects fertility - maybe I am just reading the wrong books. But I am 34 and I feel like I might have wasted 2 or 3 months of TTC. Your site doesn’t talk about tests for mycoplasma/ureaplasma - is this something you do? How do these organism affect fertility?
TGH replies,
Dear Darma,
The significance of urea/mycoplasma is controversial. I used to do the test, but couldn’t see any difference in outcomes, and found that the treatments were interminable, so I stopped. But researchers continue to look at this topic, so your doctor is not alone in this regard.
alana78
Dear Dr,
I just had my embryo transfer. It is a 2dt of 2 embryos. One 2 cell and one 6 cell. Although they do not have any fragmentation they are much slower or fater than their developmental age. Can a 6 cell develop on day 2 (48 h post insemination)?
TGH replies
Dear Alana,
yes, your embryos could result in pregnancy, though two embryos on day 2 is not as many as we often see during an IVF cycle. For more on the topic of assessing embryo quality, see my post here.
Best,
TGH
Annabelle
Dear Dr,
Due to a childhood illness i suffered with primary ovarian failure. Over the past year my husband and i have had four attempts of IVF with an egg donor. Our initial attempt was with a fresh embyro and subsequently with FET. We now have one day 5 embyro left.
I have added complications to my health suffering with metabolic syndrome (type 2 diabetes, high cholesterol, high blood pressure, etc). Due to this only one embyro has been transfered at a time.
I have been trying very hard to optimise my chances, by controlling my diabetes (HB1AC is currently 5.7%), eating well, exercising, not drinking caffiene, acupunture.
I am about to turn 35, and i hope to have our last attempt before the end of the year (last attempt was May 22nd. Do you have an advise on what could help me with a succesful implantation on this attempt.
Dear Annabelle,
With several attempts behind you, the choices ahead are not as clearcut as they may have seemed to be at first. I would consider the following:
*You mentioned a childhood condition. One of the common causes for induced primary ovarian insufficiency is childhood cancer. If pelvic radiation was required, it can affect the implantation potential of your lining. Make sure that your endometrial thickness (ET) is at least 7mm…and hopefully much more, like 9 or 11. There is no treatment for radiation damage; you would have to consider a gestational carrier if ET is a problem.
*The next thing to consider is the frozen embryo transfer (FET) success rates of your clinic. It is worth asking after the FET “implantation rate” (the success rate per embryo transferred). Quoted pregnancy rates are often much higher than implantation rates b/c unlike your situation, we usually transfer more than one embryo at a time. Many clinics have an FET pregnancy rate of about 20%, so the implantation rate may be as low as 10%…which would explain why it is taking so long to become pregnant.
*I understand that you will transfer the one embryo this time. But, if you need to do a fresh cycle in the future, think about your relationship to selective reduction. If, morally, you could handle selective reduction, then you could transfer more than one embryo at a time. Ongoing pregnancy rates per transfer in my clinic in 2008 with donor eggs were 82%…but we always transferred two embryos, and the twin rate is as high as 40%.
Annabelle, FET pregnancy rates are not as high as fresh in most centres, but those that do have success most often employ GnRH Agonist (Lupron) down-regulation as part of the cycle. We are not sure why, but Lupron may improve implantation rates for many patients.
Best,
TGH
harinder
Dear Dr. Hannam,
My wife and I were under your mediacl care in 2006, yesterday we celebrated my son’s 3rd birthday. I wanted to take this moment to express my thanks to you.
Thank you so much. It is not possible to describe in words the happiness that you gave us. You have a rare combination of not only being extremely in your knowledge base but also a very compassionate and caring individual.
May god bless you.
HS