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Pregnancy initiates a remarkable immunological adaptation to ensure the implantation and growth of the embryo. However, disruptions in this process can lead to infertility or miscarriage.

For patients with recurrent miscarriages, implantation failure, or auto-immune conditions, immune blood testing becomes valuable. Assessing immune balance can guide interventions, including medications, to enhance pregnancy chances. Our immunology blood tests, conducted at a renowned centre in Chicago, focus on vital factors like Natural Killer (NK) cells and Cytokines.

NK cells, vital for defence, can influence fertility when imbalanced. Cytokines, immune cell proteins, regulate pregnancy immune responses. Abnormalities can impact implantation and pregnancy.

Remember, immune testing and treatment are optional, and tailored to individual history and needs. Treatment options include Intravenous Immunoglobulin G therapy (IVIG), Intralipids (ILP), and possibly blood thinners like Enoxaparin and immunosuppressant steroids. These interventions aim to create a balanced immune environment for successful pregnancy outcomes.

*Immune testing and treatment is optional and is only recommended to patients on advice by your Doctor based on individual history and circumstance.*

PGT-A is a technique that checks embryos for abnormal chromosome numbers, called aneuploidy. Identifying aneuploid embryos helps prevent their use in fertility treatment, as they are less likely to result in a successful pregnancy or may lead to genetic conditions. A few cells are removed from the embryo for testing, without significantly affecting development. Though PGT-A is generally accurate, it could yield incorrect results and potentially damage embryos. Evidence from randomised controlled trials (RCTs) shows mixed conclusions, especially regarding increased live birth chances. PGT-A might have potential benefits for certain groups, like older women, in terms of reduced miscarriage rates. While PGT-A might not boost live birth rates per cycle, it could reduce time to pregnancy by enhancing embryo selection.

For Further Information you can book a consultation with our Clinic Scientist and Genetic Counsellors.

AOA, or Artificial Oocyte Activation, initiates embryo development when a sperm fertilises an egg. This process ensures only one sperm fertilises the egg. Calcium ionophores are chemicals used in the lab to stimulate egg activation.

Using calcium ionophores for AOA might lead to embryos having abnormal chromosome numbers, potentially causing miscarriage, but there’s limited evidence to confirm these risks. Studies on AOA effects show mixed results, with some indicating no significant impact on fertilisation, division, and pregnancy rates. A recent study suggests increased activation but raises study design concerns. Some studies suggest calcium ionophore could benefit patients with previous ICSI failures, enhancing fertilisation for certain cases. Further research is needed for understanding its safety and long-term effects.

For more details, refer to the HFEA website.

Assisted Hatching is a technique that involves thinning or creating a hole in the protein layer (zona pellucida) surrounding the egg or early embryo, aiming to aid its emergence or “hatching” before implantation in the womb.

While there is a slight risk (less than 5%) of harming embryos with these methods, they are uncommon. According to the National Institute for Clinical Excellence (NICE), assisted hatching isn’t recommended due to a lack of evidence showing improved pregnancy rates. NICE highlights the need for more research to assess its impact on birth rates and the outcomes for children born using this technique. Studies suggest similar results across chemical and laser hatching, indicating no significant clinical differences. Despite some clinics suggesting benefits for specific patient groups, high-quality evidence to support assisted hatching is lacking.

For further details, check out the HFEA website.

Elective Freeze All Cycles in IVF involve creating embryos through IVF or ICSI and then opting to freeze them all, with no immediate transfer. Later, in a Frozen Embryo Transfer (FET) cycle, the thawed embryos are transferred to the womb. This approach reduces the risk of ovarian hyperstimulation syndrome (OHSS).

While no known risks exist, there’s a possibility of some embryos not surviving. Research on ‘freeze all cycles’ is advancing rapidly. Hormonal responses to fertility drugs could affect the womb lining’s receptivity for embryo implantation in fresh cycles. Freezing allows embryos to be transferred when the lining is optimal, potentially leading to healthier birth weights. Some research suggests better chances of success with Frozen Embryo Transfers (FETs) compared to fresh transfers. Although it’s not conclusively established whether ‘freeze all cycles’ are more effective than traditional IVF or ICSI, there’s no evidence of decreased chances of having a baby.

For more details, check out the HFEA website.

The Endometrial Receptivity Array (ERA) test aims to determine the ideal timeframe for embryo transfer into a woman’s uterus to optimise implantation, known as the window of implantation. This involves a biopsy of the endometrial lining, and assessing gene expression. With computational analysis, the results categorise the endometrium as receptive, pre-receptive, or post-receptive, indicating the best implantation window. This personalises embryo transfer timing for increased success chances. Risks include cramping, infection, and bleeding. The procedure requires a freeze-all cycle, carrying minimal risk to frozen embryos. ERA’s effectiveness in boosting pregnancy chances has been studied, showing promise but not definitive impact, necessitating further research for reliability.

For more details, refer to the HFEA website.

For successful pregnancy, embryos must be implanted in the womb. Often, implantation fails due to incomplete embryo development or a mismatch with the womb lining. In some cases, unsuccessful implantation occurs due to an unresponsive womb lining. Endometrial scratching, conducted before IVF, involves lightly “scratching” the womb lining to stimulate repair. This is believed to enhance the lining’s receptivity for embryo implantation by releasing chemicals and hormones. 

For more details, refer to the HFEA website.

Time-lapse imaging in IVF aims to improve embryo selection for higher chances of successful pregnancy. This technique involves capturing numerous images of developing embryos without disturbing them, providing a continuous view of their growth. Embryologists use these images to select embryos based on criteria like development rate and cell characteristics, improving the chances of successful implantation. No known risks are associated with time-lapse imaging for women or embryos. Research, including randomised controlled trials (RCTs), suggests a potential benefit with increased clinical pregnancy and live birth rates, although study quality varies.

For more details, refer to the HFEA website.

Hysteroscopy and Hysterosalpingography (HSG) and Hysterosalpingo Contrast Sonography

(HyCoSy) and are important procedures for optimising fertility and assessing the health of the reproductive organs.

Hysteroscopy is a minimally invasive procedure that involves inserting a thin, lighted tube called a hysteroscope into the uterus through the cervix. This allows the doctor to examine the uterine cavity for any abnormalities such as polyps, fibroids, adhesions, or structural issues that may impact fertility. It can also be used for therapeutic purposes, such as removing polyps or fibroids.

HSG, on the other hand, is an imaging procedure that evaluates the fallopian tubes and the uterus. A dye is injected into the uterus through the cervix, and X-rays are taken to assess the flow of the dye through the fallopian tubes. This helps to determine if the fallopian tubes are open and free of blockages, which is crucial for natural conception.

HyCoSy, is an ultrasound technique used to check if the fallopian tubes are open or blocked. During the procedure, a fluid with small bubbles is placed in the uterine cavity. Using ultrasound, the flow of fluid through the fallopian tubes is observed, and it should spill around the ovaries. The fluid/bubble mix used can be normal saline with air or a specially designed fluid called ExEm foam gel.

Both hysteroscopy, HSG and HyCoSy provide valuable information about the uterine cavity, fallopian tubes, and any potential issues that may affect fertility. They can help diagnose and treat conditions that may hinder conception or increase the risk of miscarriage. By identifying and addressing these issues, fertility can be optimised, increasing the chances of successful pregnancy.