Improvement in the implantation rate

May 1, 2011

Improvement of implantation rate through endometrial stimulation

Often, everything seems to be going perfectly during the IVF ICSI treatment; however, pregnancy does not occur. One of the causes is also the ‚ability to accept‘ of the endometrium (the lining of the uterus).

There are studies that clearly show that the endometrium under the conditions of conventional stimulation IVF therapy offers worse conditions than in the unstimulated cycle. Also, every physician working in reproductive medicine is familiar with cases where, during stimulation therapy, the endometrium on ultrasound already appears to be ‚unstable‘.

Studies by independent working groups have shown that in cases of repeated implantation failures caused by targeted stimulation (injury) of the endometrium in the pre-cycle and also in the ongoing cycle, significant improvements in the implantation rate can be achieved.

• Barash et al.:
  SSR 76 %
  Live births 49 % after treatment, previously 30 % and 22 %

• L. Zhou et al.:
  Implantation rate 33.3 %
  SSR 48.3 %
  Live births 41.6 % after treatment, previously 17.8 %, 27.9 % and 22.9%

• R. Orvieto et al. (very small study):
  Implantation rate 25 %
  Clinical SSR 42 % versus 0 % and 0 % in the control group

The following facts are believed to be responsible for this phenomenon:

This irritation leads to a so-called desidual transformation of the endometrium, characterized by a strongly accelerated growth of the epithelial cells, which is also typically seen in early pregnancy.

The comparison of biopsies after pretreatment with those without stimulation showed a significant increase in gene expression of messenger RNAs (mRNA) in the study group. A significant number of various growth factors that are associated with an improvement in the implantation rate of the embryos could be detected.

These results seem to provide a further opportunity for the clinical reproductive medicine practitioner to help the previously unsuccessful patient (the „implant failure patient“) achieve success.

Study sources:

R. Orvieto – Fertility and Sterility Vol. 94, No. 6, November 2010
A. Raziel – Fertility and Sterility Vol. 87, No. 1, January 2007
L. Zhou – Fertility and Sterility Vol. 89, No. 5, May 2008
A. Barash – Fertility and Sterility Vol. 91, No. 5, May 2009

Preliminary results in our practice:

Building on the positive results of these (and other) studies, we have begun to offer this procedure to women whose previous failures in IVF ICSI treatment are not really explainable.

Our previous results support the experience of the cited colleagues, so we are very encouraged to continue offering this procedure to previously unsuccessfully treated female patients and to do so even more intensively. This procedure is also expected to have a positive effect in women with very thin mucous membranes, including in the ‚Ashermann syndrome‘.