Implantation Failure, Miscarriage

In the majority of cases when an IVF treatment cycle fails or when someone suffers a miscarriage the cause is embryo-related.

However, should couples fail to achieve success repeatedly with good quality embryos (recurrent implantation failure - RIF) or suffer from recurrent miscarriage (RM) further investigation should be considered to minimize the physical and emotional burden and ensure there are no potentially treatable causes.

In those with RIF, the exact time when these tests will be recommended will depend on factors such as age, embryo quality and number of failed cycles.

Although, some advocate testing of those with recurrent miscarriage only after 3 miscarriages, studies have suggested that as many potentially treatable causes are identified when couples are screened after 2. Therefore, again depending on other factors such as age, at the Lister Fertility Clinic we will often recommend screening at this point.

What screening options are available?

Our comprehensive screening options will be individualised according to your clinical history:

Maternal tests / treatments

Thrombophilia (clotting) Screen

We will aim to exclude a number of genetic or acquired disorders that increase the risk of small clots in the blood than can cause pregnancies to fail. These are often amenable to simple treatment with Aspirin or Heparin to thin the blood.

Reproductive immunology

Although a controversial area, some evidence suggests that an overactive immune response and in particular an increase in the numbers or toxicity of natural killer cells may impact on implantation and pregnancy outcome.

Read more about reproductive immunology

Hormonal screening

Subtle hormonal disorders such as even a thyroid function result normal for "general" health but not optimal to cope with the strains of early pregnancy should be tested for and treated if appropriate. Similarly progesterone is vital to support the endometrium (womb lining) but if rises too early can induce the lining to mature too early and not be receptive to a good quality embryo. Progesterone levels should also be checked during stimulation to ensure this does not occur and if significantly raised embryo freezing may be considered.

Anatomical screening

A more detailed assessment of the endometrium/womb may be recommended. Depending on the clinical history this maybe performed in a number of ways:

• Hysterosalpingogram: Dye may be passed into the womb to exclude a structural abnormality in the womb or collection of fluid in the tubes (hydrosalpinx) that can impact on outcome.
• 3D Ultrasound: To exclude a structural abnormality by high definition 3D scanning
• Hysteroscopy: More direct visualization of the womb lining by passing a small telescope into the womb often under general anaesthetic.

Endometrial scratch

Recent studies have suggested that stimulation of the womb lining prior to treatment may improve outcome in those with previous cycle failure.

Download our patient information leaflet on endometrial scratching

Endometrial receptivity array (ERA)

Recent studies have suggested that assessing certain genes within the lining of the womb may help determine the correct time for embryos to be transferred.

Read more on the ERA test and for whom it is recommended

Post-transfer

There are many myths surrounding the period post-transfer but in essence it can be a stressful time waiting for the test day so we encourage women to resume normal activities. The pregnancy test will be two weeks after egg collection. You will be taking progesterone supplementation at this time to support the lining of the uterus and in the event of a positive pregnancy test, progesterone supplementation is continued until week 12 of the pregnancy.

Download our cycle information leaflet for a more detailed step-by-step overview of an IVF/ICSI cycle

Paternal tests / treatments

Sperm DNA

Evidence has suggested that raised levels of sperm DNA damage may be associated with failed IVF (with ICSI/IMSI improving outcome) and miscarriage.

Read more about our sperm DNA testing service

IMSI

In those couples with recurrent failed ICSI cycles, studies have suggested that the use of IMSI, allowing us to select the sperm using higher magnification microscopes may improve outcome.

Read more about ICSI and IMSI

Genetic, embryology tests / treatments

Karyotype

A simple blood test can exclude that either partner has a subtle genetic variation that may explain either RIF or RM

Embryo selection techniques

Although they may not alter outcome as many couples have only few developed embryos, these methods may give vital information as to the potential causes of cycle failure and minimise the risk of further miscarriage.

a. PGT-A to genetically screen embryos. Read more information on our PGT-A page.

b. Embryoscope to monitor embryo development with continue time-lapse video monitoring. Read more about embryoscope.