There are many critical steps to helping initiate a successful pregnancy. The key to success is to optimize each milestone along the way. So after we’ve identified at least one healthy embryo, we direct our efforts to creating the optimal environment for implantation.
A recent study reviewed 2 years worth of data collected at 33 fertility treatment centers in Canada. In total, over 40,000 completed cycles of IVF were reviewed. They found that in women undergoing Frozen Embryo Transfer (FET), pregnancy rates declined progressively if the endometrial lining was thinner than 7 mm on ultrasound evaluation at the time of final pre-FET measurement. This had long been suspected, but had never been looked at in such a comprehensive data base.
At our center, when we visualize a thin endometrial lining we activate a series of options to try to gain more information and possibly overcome this obstacle to implantation. First, we consider newer—more definitive methods—for assessing the uterine lining. As the study cited above revealed, some patients can have a receptive uterine lining that is as thin at 4 mm—less then half the cut-off used by some fertility centers! The Endometrial Receptivity Assay is a modern test that measures the dynamic relationship between 248 genes involved in creating the ideal “window for implantation.” By using this test, we’ve been able assist many women that routinely produce a thin but functional endometrial lining proceed to embryo transfer with confidence or personalize their protocol to shift the date of the embryo transfer appropriately.
Another useful tool for us has been to add hGH to the protocol for women at risk of implantation failure. In a large randomized clinical trial, it was shown that women given hGH had achieved a pregnancy rate that was almost SEVEN TIMES HIGHER than those that did not receive this therapy. So many women that would have previously been redirected to use a gestational carrier—can actually carry and deliver their own pregnancy.
As always, each individual case is different. But if you think you may be at risk of implantation failure it isimportant for you to remain aware of the emerging research into this often overlooked problem.
Robert Greene, MD, FACOG
Conceptions Reproductive Associates of Colorado