17 Sep Implantation after IVF: 10 crucial tips
Can you improve implantation chances after an IVF embryo transfer? It’s the question all our patients ask. Your embryo transfer went well. Your expectations are sky-high. You’ll do anything to make implantation happen. So here are 10 tips to improve your implantation prospects after an IVF cycle.
1. Take time off.
We mean it. Implantation takes place 1 to 5 days after a blastocyst transfer. (If you didn’t have a day-5 transfer, your implantation window is 6 to 10 days after egg retrieval. Take that week off. There’s no hard evidence that being home alone helps – but research isn’t everything. Stay at home. Take it easy. Watch TV. Don’t stress. Be anywhere except the office. This is your time.
If you’re worried about what your employer thinks, remember this. In the UK at least, employers should treat IVF appointments and sickness like any other medical matter. Talk to your boss. An understanding employer should also be receptive to flexible working around your IVF treatment. Or paid or unpaid leave.
2. Go for blastocysts. And put in two. Maybe.
Research says blastocysts have higher implantation rates than younger embryos. You need great embryos (and a receptive uterus) to maximise implantation after IVF. Sure, your doctor will tell you day-3 embryos can make it. But if your embryos develop into good-quality blastocysts, things may turn out better. Transferring a hatching or expanding blastocyst makes implantation even more likely, particularly a top-grade one.
How your embryos develop is, of course, out of your control. If you’re over 40, the plain truth is that donor eggs and donor embryos deliver the best implantation rates. Putting in two, where each embryo has an equal chance of implanting, may be a risk worth taking when you’re older. Talk to your doctor. While single embryo transfers are now routine, and safer, transferring two may occasionally be the better call. More so for frozen embryo transfers.
3. Get your lining in shape.
Implantation can’t happen if your endometrial lining is too thin. It’s vital to check how your lining is thickening during an IVF cycle. 7 mm is the target on transfer day. But 8 mm or more is optimal. If you’re having donor eggs, donor embryos or an FET, you’ll be on estrogen. Check your lining thickness at least four days before you’re due to add in your progesterone. This gives you time to adjust your estrogen intake if needed.
Your estrogen format is important. Most of our patients take pills (e.g. estradiol). But patches and estrogen gel can work better for certain patients. For those with serious lining growth issues, using two or three formats at once can work well. Talk to your clinic about your estrogen format and dosage. Your implantation chances could be higher after that chat.
4. Implantation foods? Tread with care.
Google pineapple and you’ll read it’s good for implantation. Nonsense. The same goes for green tea, raspberry leaves, bananas, tofu and 101 other so-called implantation foods. If your uterus needed specific foods to boost implantation, your clinic would have prescribed them. How many Mongolian yams does your pharmacy keep in stock?
The reason it’s dangerous to fixate on specific foods around implantation is that they may cause more harm than good. They detract you from what you should be doing: eating a balanced diet from at least three months before your fertility treatment starts. Avoid processed foods, limit your sugar, eat good carbohydrates, add in oily fish twice a week, don’t neglect proteins and pulses, take a daily multivitamin with folic acid… you get the idea.
A recent study on foods and embryo quality did show that a high BMI, being on a weight-loss diet during fertility treatment and red meat consumption reduced implantation prospects. That same study also confirmed the fairly obvious: cereals, vegetables, fruits and fish were good for embryos (and therefore implantation), while smoking and alcohol were bad.
5. Your uterus loves progesterone. Take the right one.
Progesterone makes your uterine lining super-receptive. Taken from egg retrieval day, it prepares your endometrium to receive your embryos in style. But some progesterone supplements are more equal than others. We took intramuscular injections (Gestone, Agolutin). These progesterone-in-oil shots release the hormone slowly and evenly throughout the body. No messy pessaries or oral pills that give you side effects.
Utrogestan pills, taken vaginally, are also a safe bet for implantation. These allow your clinic to adjust your dosage in the case of bleeding (although bleeding a few days after your transfer may just be implantation bleeding). Sub-cutaneous Lubion injections are also good, though expensive, and are best used as a progesterone supplement where bleeding occurs.
So which are better for implantation – vaginal or intramuscular injections? A new Chinese study surprised us. Vaginal progesterone led to higher implantation rates, compared to IM injections, in frozen embryo cycles.
6. Screen those embryos… unless you used a donor.
Fact: older women produce poorer-quality eggs. Another fact: embryos produced by older women have a higher chance of chromosomal abnormalities. If you’re an older patient having IVF with your own eggs, it may be worth having PGS testing to screen out chromosomal problems. Or, more practically, transfer one embryo during the fresh cycle and freeze and test the rest.
PGS is not for everyone. Donor-egg recipients don’t really need it, for example. But genetic screening has greatly improved over the last few years. Recent research showed that implantation rates were significantly higher when genetically tested blastocysts were used.
7. Fertility add-ons? They’re worth revisiting.
Five fertility add-ons may boost IVF implantation rates. But don’t go ordering all of them. They vary in effectiveness and price, and your clinic is best placed to recommend which to have, if any. But some have gained traction in terms of the supporting research behind them. Here’s the list:
(i) Embryo glue could improve implantation rates in patients with a history of recurrent miscarriage or pregnancy failure.
(ii) The ERA test may also help achieve implantation, by pinpointing the optimal time for your embryo transfer. But it’s an expensive test and surgically intrusive.
(iii) The Embryoscope, and other time-lapse cameras, can help to identify the best embryos to transfer. This may have a positive effect on implantation.
(iv) A low-dose steroid like Prednisone may reduce natural killer cell activity in your uterus. It’s an immunological safeguard aimed at improving implantation rates.
(v) Blood thinners like low-dose aspirin and Clexane may reduce the chance of a blood clot in the developing placenta. Patients with certain blood disorders may well need one or both. Others with a miscarriage history or past implantation failure may also benefit.
8. Light spotting? Could be good news.
Implantation bleeding or spotting after an IVF cycle is common. In fact, 1 in 4 women typically experience implantation bleeding. Look out for a little light spotting – a pink or brown discharge – 5 to 7 days after your transfer. If it’s accompanied by mild cramping, things may really be going your way. Whatever happens, don’t stop your medication. Do a pregnancy test on the correct day (typically 14 days after your ET).
9. Have a scratch – but needle your doctor first.
Endometrial scratches were all the rage two or three years ago. The research initially looked promising. In the days leading up to the menstrual bleed at the start of your IVF cycle, a surgical scratch of your uterine lining may prime your womb for implantation. Ask your clinic if they’ll do it, or knows someone who does. If you’re having a hysteroscopy, time it right and have an endometrial lining scratch at the same time.
There’s a but. It’s an uncomfortable and intrusive procedure. We’ve noticed our clinic recommending it less frequently, mainly to patients with a very pronounced implantation failure history. A recent study cast doubt over its effectiveness. The jury is out.
10. Relax. But no baths.
Hot baths and implantation don’t mix. Or at least, there’s some evidence that sitting in hot water for long periods isn’t a good idea. So play safe: have quick, two-minute, warm showers and abandon the bubble bath for a few weeks. Relaxation is key – just don’t do it in the tub around implantation time!