Methods to Enhance Embryo Implantation
By Dr. Edouard Servy|March 7th, 2021
First of all, it must be stated that at least 50% of embryos are abnormal. Therefore, most of the failures of implantation, biochemical pregnancies or early miscarriages are due to the fact that the embryos, despite looking normal under microscopic visualization, are missing a chromosome or having an extra-chromosome, making them incompatible with life.
Some failures of implantation can be due to infections -that can be easily corrected with antibiotics- or immunological problems -that would require a treatment with steroids-.
Other possible causes could be hormonal -deficiency in progesterone or estrogen support- but they are automatically prevented when our protocol of hormonal treatment is properly followed.
Finally, the endometrium might not be adequately receptive to the embryo. Therefore, when dealing with repeated or unexplained failures of implantation, we may perform endometrial scratching or uterine HCG infusion.
Then, there are the methods that have been advertised by some other clinics or read on Google that we feel are costly, unproven and unnecessary.
Possibly useful methods, performed at the Servy Fertility Institute
Several studies and observations published in the 1970’s, before the advent of IVF have shown an increase in spontaneous pregnancies in infertile couples following the cycle when an endometrial biopsy was performed. So, this is not new.
It’s most beneficial in women with recurrent implantation failures who have at least one trial of Assisted Reproduction. Therefore, this method can be used as treatment strategy to improve fertility in women with prior failures.
It could be uncomfortable, but it’s a harmless and inexpensive procedure that should preferably be performed during the cycle preceding embryo transfer.
HCG production naturally begins the second day after fertilization. It’s important for implantation of the embryo as it chemically alerts the endometrium of its presence and prepares it for implantation. Intrauterine HCG injection has been shown to accelerate the secretory parameters. This technique was first used in the early 1990’s.
More recently, we performed a pilot study that confirmed that the process may enhance embryo implantation. The pregnancy rates were 45% in patients with previous failures. It was advised to perform the HCG intra-uterine infusion the day of or the day before embryo transfer.
Intrauterine injection oh HCG to enhance embryo implantation. Jessica R. Kanter, C. Pollitzer, A. S. Rao, E. J. Servy, J. Massey et al presented at the annual ASRM meeting. Oct.28 to Nov. 1, 2017
Methods that are not performed in our clinic.
First do no harm: uterine natural killer (NK) cells in assisted reproduction:
Natural killer (NK) cells are a type of lymphocyte circulating in peripheral blood named because of their effector functions in killing target cells. Immune cells that share similar phenotypic characteristics but are poor killers populate the uterine lining at implantation and during early pregnancy when the placenta is established. The functions of these uterine NK (uNK) cells are essentially unknown but available data point to a role in regulating placentation in concert with other elements of the decidua and invading trophoblast cells.
Despite the lack of scientific rationale and advice from clinical governing bodies, such as the Human Fertilization and Embryology Authority, an increasing range of tests and therapies are still offered to women undergoing IVF or attending recurrent miscarriage clinics based on the myth that uterine NK cells need suppressing to prevent damage to the embryo. New treatments can be introduced at whim with subsequent demands for expensive trials to prove/disprove their efficacy. The evidence that targeting uNK or peripheral blood NK cells assists women with recurrent pregnancy failure is lacking. Healthcare professionals and patients should very carefully evaluate the practice of immunomodulation to enhance pregnancy outcome. A discussion on how to move towards stricter regulation of immunotherapy in non-hospital settings is now needed because it is clear that the potential risks and costs of these therapies outweigh any benefits.
Common side effects of Intralipid 10% include:
Headache, dizziness, flushing, drowsiness, nausea, vomiting or sweating.
NK cell activity can increase by consumption of nutritious foods the Five Food Groups, supplemented with blueberries, Maitake mushroom, garlic, Resveratrol, Quercetin, and probiotics.
Hyaluronic acid, also known as hyaluronan, is a naturally occurring glycosaminoglycan with viscoelastic properties. It’s a highly purified viscoelastic solution obtained from chicken combs or bacterial cells. It has been used to treat knee pain caused by osteoarthritis.
Lately, some companies specialized in culture media have advertised for products such as (1.) UTM (Uterine Transfer Medium) from Medicult: Hyaluronan-rich transfer medium, claiming that it significantly improves pregnancy rates.
(2.) Embryoglue from Vitrolife: Bicarbonate buffered medium containing hyaluronan and recombinant human albumin. Implantation promoting medium for increased take-home baby rate.
Our clinic and several American and European clinics have used the product at the time of embryo transfers in the late 1980’s and early 1990’s, to try to improve the success rate in embryonic implantation. None of the clinics have seen their results improved with the use of hyaluronic acid. All clinics have concluded that it’s an additional costly and unnecessary procedure. Therefore, we are not advising the use of hyaluronic acid at the time of transfer.