Failed Embryo Transfer: Why am I not getting pregnant? New Hope Fertility Center NYC

Today, I will like to talk to you all about a question, which I’m sure all the fertility doctors have to discuss about on a daily basis. I, of course, have to have this kind of conversation every day. The question is:
Dr. Zhang, I have in-vitro fertilization, so called IVF, procedure done. I have this amount of embryos transferred but I’m not getting pregnant. Why am I not getting pregnant? They told me that my embryos looks great. I am so careful and I am doing everything that you said. But why am I not getting pregnant?
So I want to discuss this question with you.
While we want everybody to get pregnant, we do everything possible trying to improve everybody’s chance to get pregnant. But nevertheless, we just couldn’t get everybody pregnant at any time. And this is the question that we all have to discuss about. So, let’s talk about this subject.
The answer is one of the two. If you are not getting pregnant after embryo transfer, either the quality of the embryos are not good enough or your environment, your body, the uterus, or the uterine cavity, are not optimal to receive the embryos. So this will be one of the two reasons. 70% of the time is due to the embryo quality and 30% of the time is due to endometrial environment, your body. While there is no crystal ball, there’s no technology that can confirm in any failed embryo transfer, whether it belongs to the embryo quality or due to the endometrial environment.
But as I said, 70% of the time is due to embryo quality. Then to further figure out whether in each individual case, whether it is due to endometrial environment or embryos, we can look for a few hints. If the lady, aged 39 years or older, if the embryo was not blastocyst stage embryo, or morphology is perfect, then most likely it is embryo quality.
If the lady is 35 years or younger, and never got pregnant before, and the embryo look super, a very good quality embryo, but they are not getting pregnant, that could be the endometrial environment. So if it due to the endometrial environment, then we will do further investigation by chemically. We can check the blood for specific antibodies or factors that are against embryos implanting. We can look at the physical environment of the uterus. We can do ultrasounds. We can do special ultrasounds. We can do hysteroscopy to look at the inside of the cavity and look for subtle pathological changes that may prevent embryo from implantation.
If we think it is embryo quality, then of course we can try to change the protocols. Try to do the retrieval at a different time, to see if it can improve the egg quality by means of seeing if the embryo can make it to the so called blastocysts stage embryo.
By the way, I just want to cut in and explain a little about how we can have a better knowledge about the quality of the embryos. Three things we can do: a) look at the morphology, basically look at the shape/image of the embryo. If the embryos can make it all the way to Day 5, Day 6 embryo, so called blastocysts stage embryo then the embryo have a good chance to be a good quality embryo. We also can estimate the quality of the embryo by looking at the age of the patient. If the embryo is produced from a patient who is 38 years or younger, then there’s a good chance to have a good quality embryo. If they are 40, 41, 42, there is an increased chance of poor quality embryo. This is how we can hint at the quality of the embryos.
Now I am sure you all know about a new technology called Pre-implantation Genetic Screening (PGS) test, which you can take a few cells from an embryo, the so called blastocysts stage embryo. Then we can do the advanced technology using the molecular technology called Next Generation Sequencing, or Comparative Genomic Hybridization, the abbreviation is CGH, or NGS. Then we can further check the number of chromosomes of these embryos. Then you can get further information about the quality of the embryos. And indeed, if the embryo can make it to blastocysts stage embryo and the NGS test prove the chromosome number is normal, and this embryo will have at least 50% to get patient pregnant. So this is the way to figure out the embryo quality.
If patient can move on to the next step, then we can work on both side, and try to improve the quality of the embryo and also thoroughly evaluate the uterine cavity.
Thank you.

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