Repeated embryo implantation failures pose a challenge for women and couples who wish to start a family, as well as for fertility experts. It is estimated that between 70% and 75% of embryos created, either through natural conception or via IVF, fail at some stage in their development before implantation occurs.   

There are many reasons why an embryo doesn’t attach or implant, and fertility expert Ms Srividya Seshadri explains how we investigate repeated implantation failure (RIF) at Aria.

Q: What is the definition of recurrent implantation failure?

There are numerous medical definitions in the literature of recurrent implantation failure or repeated failed IVF cycles, but generally, it is defined as two unsuccessful transfers of two good-quality embryos.

Q: What are the causes of recurrent implantation failure?

There are multiple causes of recurrent unsuccessful IVF cycles. I segregate them into two main parts. Is it the embryo, or is it the womb itself that’s resulting in an unsuccessful cycle?

Let’s look at the embryo. We all need to remember that the embryo is formed in the laboratory. I believe the success of any fertility clinic is largely dependent on the lab. Aria has a bespoke laboratory with cutting-edge technology and highly skilled embryologists that have the patient’s success at heart.

Then, there is the endometrium, or the lining of the womb. Multiple factors can result in a failed or unsuccessful IVF cycle, and one of them could be endometrial receptivity. Are we getting the timing right of the transfer, and is there any delay in the receptivity window that’s resulted in the unsuccessful cycle?

Or could it be selectivity that the lining doesn’t seem to recognise this beautifully normal, good-quality embryo? Could other anatomical factors, such as fibroids, endometriosis or hydro-salpinges, which means water in the tubes, interfere with success rates?

Q: How soon can we try again after a failed IVF cycle?

Regarding how long it takes to wait before you start again, I always advise couples that it is an individual choice. I’ve had patients who have struggled with the side effects of drugs from their previous cycle and who are emotionally drained. Do not let medicine dictate to you when you need to start.

In essence, though, once you’ve had a withdrawal bleed after an unsuccessful cycle, you can start the transfer process immediately. However, I always tell my patients that we need to find out why something has not worked out before we rush into another transfer because, quite often, this will result in another unfortunately unsuccessful cycle.

Q: What tests are required after an unsuccessful IVF cycle?

The tests that must be performed after an unsuccessful IVF cycle depend on the individual couple’s history. I could list pages and pages of tests that we could order, but are they all necessary?

The tests could include thrombophilia, which checks whether you have an inherent capacity to overclot rather than underclot, which may be easily treated with heparin injections before and during treatment.

Or should you check to see if the lining has an infection from a previous loss or any previous operations you have undergone?

Is immune testing necessary? Absent evidence does not mean the absence of evidence. We all believe immunology plays a role in kidney, heart, gut issues, and even early dementia. But, when it comes to reproduction, everybody gets very nervous. Please look on the UK’s fertility regulator website for more information or discuss this with one of the consultants at Aria.

A detailed history, evaluation, and discussion with your consultant to discuss all possible causes and necessary tests are essential stages of managing recurrent implantation failure. Contact us to arrange a consultation.

Award-winning dietitian and founder of Fertility Dietitian UK Ro Huntriss has been supporting individuals and couples undergoing fertility treatments for many years. Recently, she embarked on her own fertility journey when she decided to freeze her eggs at Aria Fertility.

I’ve worked in the fertility sphere for a good few years now, and I’m very aware of egg freezing and its potential benefits.

I am 37, and I love my career, travelling, and spending time with my friends, so I had considered egg freezing. However, I was in a long-term relationship and out of nowhere, the relationship broke down very suddenly. I made the swift decision to freeze my eggs.

Making the choice to freeze my eggs

I don’t know what the future holds for me with regards to children, but I wanted to make a very positive decision in the middle of an uncertain time. Egg freezing represented an empowering choice. If I want to go on and have children, I’ve done what I can to facilitate that.

Preparing for my egg freezing treatment

Through my work, I’m seeing more and more patients who are about to embark on egg freezing, as there is so much you can do through your diet and lifestyle to influence your outcomes, including increasing the quality of your eggs and also the number collected.

Some women may have had an unsuccessful round and want to improve their chances, but there is also a growing awareness about the importance of preparation before they even begin. Egg freezing is a significant investment in time and money, so delaying your procedure for three months to improve egg quality and quantity makes absolute sense.

Stress and other lifestyle factors are also things to consider as there are many things that can affect our fertility so it’s wise to look at things from several angles.

So, I did everything I could do from a diet and lifestyle perspective to optimise my chances. This was very holistic, as everything I was doing made me feel better and did good things for my body. There’s no downside to making these positive changes.

My egg freezing journey

My egg freezing process went smoothly. I had the advantage of working in the industry, so I understood the process better than most people going into it. The most important part of it is finding a clinic that you like and that you’re comfortable with.

You are with that team for some time and want to feel cared for and seen as a person with a story and not just a number.

I knew of Aria beforehand and had met the clinicians, so that was a positive for me. But after speaking to the team members, I just felt very comfortable and supported.

I wasn’t sure how I was going to be with needles; I’m not needle-phobic, but I wasn’t sure how painful it would be. However, it was fine. I felt bloated towards the end, which makes sense as you have so much more fluid there, so it wasn’t unexpected. It does feel like your life is on hold for a bit.

They collected 13 eggs. The optimal number is 15 to 20, but this was still a pretty good result for my age from one cycle so I decided not to repeat the procedure because I was so close to the optimal number, and the quality of eggs was good. I’m also in a place where I’m not sure I want to have children, so I felt very happy with what I’d achieved and ready to move forward with the rest of my life.

Egg freezing was a positive step for me and I’m really glad I did it. It increases my chances of having children should that be my path, so I’d encourage others to consider it if they find themselves in similar positions, or who may be considering having children later in life.

You can watch Ro’s journey as the BBC’s Anna Collinson meets the people taking the chance to try and preserve their fertility in Egg Freezing and Me.

Emily Patrick and Kerry Osborn recently made UK history by being the first to give birth to each other’s babies in a process known as simultaneous reciprocal IVF. Ezra was conceived using Emily’s fertilised egg and carried by Kerry, while Elvis, born just a few weeks earlier, was carried by Emily using Kerry’s egg. The same sperm donor fertilised both eggs.

What is reciprocal IVF?

Reciprocal IVF is also referred to as shared motherhood, co-maternity, shared parenthood or intra-partner egg donation. It is a fertility treatment option that allows both partners in a same-sex female relationship to participate in the experience of conception and pregnancy.

If you choose to undergo reciprocal IVF, eggs are collected from one partner and fertilised in our lab using donor sperm. The most suitable embryo is then chosen for transfer into the other partner. Considerations include:

Choosing which partner will be the donor and which will be the carrier

At the beginning of your journey, both you and your partner will undergo a fertility check. The partner donating her eggs should have a good ovarian reserve, which is assessed by an ultrasound scan showing the number of follicles on each ovary, the small fluid-filled sacs that can potentially release an egg. Blood tests are also performed to measure certain hormones, such as anti-müllerian hormone (AMH). Low AMH levels can indicate a low ovarian reserve.

A pelvic ultrasound scan will also be performed to check the health of your and your partner’s uterus to facilitate a successful implantation.

These factors can highlight who is most suitable to be the donor or carry the pregnancy. However, if both of you have no fertility issues, it is up to you to make a personal choice, and we can provide you with our expertise and support when making that decision.

Understanding the risks

Neither role is free of risk as you’ll both be taking fertility medications, and both may experience side effects. Then, one partner will be going through pregnancy and childbirth.

As in the case of Emily Patrick and Kerry Osborn, if you are undergoing simultaneous or concurrent reciprocal IVF, then this may also mean unforeseen challenges as you may have very different experiences of pregnancy and childbirth.

Choosing the right sperm donor 

You can either use sperm from a known donor or from a sperm bank. At Aria, we provide the facility for sperm donors to donate their sperm on a known basis to either a friend, family member or someone else known to them.

We also work with several established sperm banks and can help advise and support you through the process. We will also inform you on when you should order donor sperm in advance of your treatment.

Understanding the legal implications

Understanding the legal implications of using a sperm donor and reciprocal IVF is vital. For example, if you and your partner are married, you are both the legal parents to the child born. However, you must consent to legal parenthood if you are not married before receiving treatment.

If you use sperm through a sperm bank, there are strict regulations regarding donors. A sperm donor can request confirmation of the number of children born, inducing gender and year of birth, but otherwise, the identity of the child and mother will remain anonymous. The donor will have no legal or financial rights or obligations in relation to the child. At the age of 18, your child will have the right to basic information about their sperm donor if they wish.

Using a known donor can be more complicated, so it is vital to obtain legal advice and consider a donor agreement. While they are not legally binding, they record the intentions of all involved.

Our team is here to answer any questions you may have and support you through the process of reciprocal IVF.

International Day of Women and Girls in Science is marked every 11th February as a global celebration of the accomplishments of women in science and to encourage young girls to consider a future career in STEM fields.

Francisca Mora, Senior Clinical Embryologist at Aria, along with clinical embryologist Summer Sorensen and embryologist Kim Hill, share their knowledge and unique insights into the fascinating field of embryology.

What led you to pursue a career in embryology?

“I’ve always known I’d work at something related to obstetrics. My parents say that I was always drawing pregnant women and babies when I was a child, maybe that was a tell?” Francisca reveals.

For Summer, the fascination with fertility started at High School when she attended a Science and Technology Forum and the keynote speaker explained all about the wonderful world of IVF. Kim undertook a Medical Physiology post-grad degree in South Africa that allowed her to be a part of the Reproductive Research Group, where her focus was on male fertility and nutrition.

What education / training did you go through to become an embryologist?

Before working in IVF in the UK, all three of our embryologists first studied in their home countries.

Summer completed a Bachelor of Biomedical Science (majoring in Reproduction, Genetics and Development) before completing a Bachelor of Biomedical Science with Honours, both at the University of Otago in New Zealand. She then completed her Masters of Clinical Embryology at Monash University in Melbourne, Australia.

Her first job was a trainee position at Fertility Associates in Auckland, New Zealand where she learnt all the necessary skills of being an embryologist.

Kim completed a BSc in Human Life Sciences & Psychology at Stellenbosch University in South Africa, then completed a Master’s Degree in Clinical Embryology at the University of Dundee.

After completing her MSc, she worked as a lab technician before advancing to a trainee embryologist. “I had in-house training, in both private and NHS settings, up to biopsy practitioner, before applying for professional registration. In this time, I also gained accreditation by the European Society of Human Reproduction and Embryology (ESHRE) as a Clinical Embryologist.”

Francisca holds a BSc and MSc Biochemistry from leading Portuguese universities. “I’ve also conducted my master’s thesis on the topic of male infertility. However, I’d say that my training didn’t start until I set foot in an IVF clinic and since then it has been an ever-growing experience, we are continuously learning! Since I’ve moved to the UK, I’ve learnt a great deal through colleagues, workshops, talks and the HFEA. Furthermore, acquiring my professional registration, has also been a key moment in my training.”

How do you stay current with the latest research and advancements in embryology?

“Aria Fertility supports an environment dedicated to improving outcomes through innovations in technology,” Kim explains. “Staying current with scientific advancements and professional recommendations enables us to provide state-of-the-art patient care.

This can come through a variety of sources. “Reading the latest scientific journal articles, attending conferences, LinkedIn, workshops, these are all useful,” Summer adds.

“Moreover, one of the most practical ways is to keep an eye on the embryology hubs that exist online; in that sense, social media has been very helpful in diffusing the latest developments,” Francisca points out.

What is the process or protocol that has most surprised you in terms of development and research?

“I’d probably say that trophectoderm biopsy, used for genetic testing (PGT), has been the process that surprised me the most,” Francisca explains. “Not only because I had not seen it before until I moved to the UK but was well for the level of detail and technical skill that it entails. It’s also a protocol that has evolved quite a lot in the last years, especially the technique used at the genetics lab to detect the abnormalities.”

How have recent advancements in embryology, like genetic screening, affected your work?

Both Kim and Francisca feel that genetic screening has greatly expanded their skill set and how they can guide patients through their treatment. “I became an embryo biopsy practitioner about a year and a half ago so the whole process is still very exciting to me,” Kim explains. “It is a valuable skill set to have, and unique as not all clinics provide genetic testing to their patients.”

“On one hand, such processes have made my work more challenging, in a positive way, since it has raised the bar for my skills and knowledge,” Francisca agrees, “and on the other hand, it has made it easier to guide patients on their treatment, as genetic screening can provide crucial answers.”

Summer feels that the greater awareness of egg freezing has had a huge impact on the fertility sector. “While egg freezing isn’t necessarily a new technology, I have really enjoyed the rise in awareness of this technology in the public space, and how more and more women are thinking about and planning their reproductive futures.”

What are some of the most exciting future possibilities in the field of embryology?

All three embryologists agree that AI will be the big focus in IVF. “It is very interesting to see what avenues are being explored and how this may impact our day-to-day procedures and the positive influence on our patients’ goals,” Summer explains.

“However, there will always be a need for a human embryologist on the other end of the line to support patients through the emotional impact and big decisions involved in IVF,” adds Kim.

Another possibility is creating eggs and sperm from stem cells. “I feel the possibility of creating gametes from other cells of one’s body could be a reality at some point, and this could bring hope to oncology patients,” Francisca expands.

Beyond the lab, what role does communication play in your job?

“As a clinic, we feel communication with our patients is one of the most important aspects of their treatment, for them to understand the process, the risks and to ask any questions they may have,” Summer explains.

“Patient interaction is my favourite part of the job,” Kim agrees. “I love explaining what goes on so that patients don’t feel the lab is a ‘black box’ of unknowns, and the decisions can be made together.”

Communication between team members is also vital. “Considering we all work under a lot of pressure and in a confined space, it’s super important to communicate effectively with colleagues to ensure that everything goes as smooth as possible,” Francisca explains.

“This helps when liaising with patients who can tell there is really good communication amongst the lab and greater team,” Kim agrees.

Is there a ‘typical’ workday at Aria Fertility?

“I’d say that each day can be quite different, as there are no equal cases, however there is a main structure that is followed every day,” Francisca explains.

The mornings tend to be busy with fertilisation checks, thawing embryos for embryo transfers later in the day, egg collections, embryo grading and sperm preparation. The afternoons are typically filled with inseminations (either conventional IVF or ICSI -sperm injection into the egg), embryos transfers, preparing for the next day and diagnostic sperm analyses.

What is the hardest part of your job?

Our embryologists all agree on what is the hardest part of their job.

“It’s without a doubt having to give bad news to the patients or to see that their treatment wasn’t successful,” Francisca explains. “Each failed fertilisation, negative pregnancy test, each pregnancy loss really takes a toll on all of us at Aria Fertility.”

“It never gets easier to tell a patient that is hasn’t worked this time,” Summer agrees.

“We want every outcome to be a success, but unfortunately science is not that robust yet, and this is a huge drive to keep developing the research behind IVF so we can better the chances of success,” Kim resolves.

What is your favourite part of your job?

“My favourite lab procedures are egg collections and ICSI. But, overall, my favourite parts are the conversations with patients, and ultimately having a helping hand in our patients realising their dreams of becoming parents,” Summer believes.

“I love it when patients return with a healthy baby for cuddles, after seeing them as a tiny embryo in the lab,” Kim agrees. “This makes every tough day worth it, knowing that so much joy is coming from it. I love speaking with patients and helping to guide them through the difficult decisions they need to make. I love working with the team as we all share common goals, and that is to see each patient journey end in success.”

“I truly value the fact that we can guide patients through their treatment and to be able to explain to them the latest scientific developments that we implement, but I also quite appreciate the fact that each day in the lab is different, each patient is a new opportunity of success,” Francisca adds. “Furthermore, in order to be an Embryologist, one has to have a broad spectrum of knowledge, from Biology to Law, Mathematics to Pharmaceutical Sciences, etc. and personally I enjoy this side of my job.”