IVF miscarriage & implantation failure

Sadly, IVF treatment cycles are not always successful. After an embryo is transferred during IVF, there are two common causes for the pregnancy to fail:

• The embryo doesn’t implant properly in your womb. This is known as implantation failure.¹
• The embryo does implant in your womb, but the pregnancy fails at a later point. This is miscarriage.

These are often a result of a problem with an embryo that happens by chance and can’t be prevented. But if you’ve experienced several IVF implantation failures or miscarriages, despite using good quality embryos, your consultant will usually want to check for any underlying causes and try to find a more positive treatment path.

They might also suggest some ‘add-on’ treatments to boost your chances of conceiving next time.²

These tests are usually only recommended if you’ve had two or three failed IVF cycles or miscarriages, but your consultant will also consider your age and the quality of your embryos before suggesting them.¹

IVF treatment is a complex and delicate process. If your IVF treatments have repeatedly ended in implantation failure or miscarriage, it might be due to several underlying causes, including: ^1,3

• Blood clotting disorders
• Hormone disorders
• Anatomical disorders
• Problems with your womb lining (endometrium)
• Changes in your microbiome (the bacteria that normally live in your vagina and reproductive system)
• Your immune system’s response to pregnancy
• Problems with the sperm
• Chromosome and other embryo abnormalities

Your lifestyle can be a factor too. Your chances of successful IVF treatment can be affected by smoking, the amount of alcohol and caffeine you drink, and your weight.^1,3

If you’ve had repeated implantation failure or miscarriage after IVF, we can help determine what’s causing it. We offer a comprehensive range of tests and screenings at HCA UK, and your dedicated fertility consultant will talk you through your options, your wishes and what’s best for your specific situation.

They might recommend one or more of the following tests:

Blood clotting screening: You may have a condition that increases blood clotting, which can cause your pregnancy to fail.1,3 We can carry out screening tests to see if any of those conditions are affecting you, and if you’d benefit from taking aspirin or heparin to thin your blood.1,3

Hormonal screening: These are tests to look for any hormone disorders that may be affecting your pregnancy, including subtle changes in your thyroid function. If your thyroid levels are too high or too low, your consultant might recommend treatment to bring them back to a normal level.¹

We can also check your progesterone levels during your pregnancy. If your progesterone levels rose too early during your cycle, it could have caused your womb lining to mature too fast and made it less receptive to the embryo implantation.¹

If that’s the case, you have the option to freeze your embryos so they can be transferred at a more suitable time in your cycle.¹

Anatomical screening: You might have a condition in your womb that’s affecting embryo implantation, such as fibroids, polyps, adhesions or endometriosis. Your consultant might ask for a scan or procedure to get a more detailed look at your womb.

Those might include^1,3

• A hysterosalpingogram. This is an X-ray examination that uses a dye to show up your womb and fallopian tubes in detail.
• A transvaginal ultrasound. This scan takes an ultrasound of your womb through your vagina. It provides a high-definition 3D scan that gives your consultant the clearest possible picture.
• Hysteroscopy. This procedure uses a small telescope called a hysteroscope to get a more direct visualisation of your womb lining.

If your consultant finds any underlying problems that are affecting your chances of a successful pregnancy, they can suggest treatments before your next IVF cycle.¹

Tests and treatments on your womb lining: Problems with your womb lining (endometrium) can often cause implantation failure. There are several tests we can do to find out if that’s happening:

• The Endometrial Receptivity Array (ERA) test involves taking a sample of your womb lining to test how well it will receive your embryo. Once we know, we can plan the best time to transfer your embryo to give it the best chance of successfully implanting.
• During your ERA test we can also check for any infection in your womb lining and check your microbiome as well.  If your consultant finds any abnormal bacteria, they can prescribe antibiotics and probiotics before your next IVF cycle.
• An ‘endometrial scratch’ is a procedure to stimulate your womb lining before starting IVF. It involves ‘scratching’ the lining of your womb to make it more receptive to embryo implantation.^1,3

There’s limited data about how effective these procedures are. Your consultant will only recommend them if they’re suitable for your specific circumstances. 

Sperm tests and selection techniques: There’s evidence that raised levels of sperm DNA damage may be associated with failed IVF and miscarriage, although it isn’t conclusive.^1,3 We can test sperm to see if there’s a high level of DNA damage and if there is, your consultant might recommend intracytoplasmic sperm injection (ICSI) instead of IVF.  ICSI involves injecting sperm directly into the egg.

If you’ve already tried ISCI several times, your consultant might suggest intracytoplasmic morphological sperm injection (IMSI) instead. It’s a different version of the ICSI technique that uses a high-powered microscope to get a better idea of the sperm’s shape.

Chromosome tests: There’s a simple blood test called karyotyping that can check whether you or your partner have any abnormalities in your chromosomes. These abnormalities can be passed onto embryos and lead to repeated implantation failure or miscarriage.1 If we find any problems, pre-implantation genetic testing can help to increase your chances of a successful pregnancy.

Embryo selection techniques: Screening embryos can help give your consultant vital information about what might be causing implantation failure and minimise any risk of miscarriage. There are two ways to screen your embryos:

• Pre-implantation genetic testing genetically screens embryos to look for abnormal numbers of chromosomes.¹
• Embryoscope This is continuous, time-lapse video monitoring of your embryos, to help select the embryos which have the best chance of being successfully implanted.