IVF & Treatment Basics
Good blastocysts but still no pregnancy? Implantation failure has specific, treatable causes ERA testing, chronic endometritis, PGT-A, hysteroscopy. Dr. Rajesh Modi explains what to investigate next.
One of the most puzzling IVF situations is when you have good-quality embryos well-graded blastocysts but they still don’t implant. Everything looked right on paper. So why didn’t it work? This is one of the questions Dr. Rajesh Modi hears most often from patients who have experienced one or more failed embryo transfers, and it deserves a thorough, honest answer.
Implantation failure despite good embryos can stem from several sources. The endometrium (uterine lining) may not be receptive at the time of transfer the 'window of implantation' is a narrow timeframe, typically 5–7 days after ovulation or progesterone start, when the uterus is most receptive. An ERA (Endometrial Receptivity Array) test can identify whether this window is in the standard timeframe or shifted — called 'displaced implantation window' allowing the transfer to be timed precisely.
Structural uterine issues, polyps, fibroids (submucosal), adhesions, or a uterine septum can physically interfere with implantation. A hysteroscopy is often recommended for patients with recurrent implantation failure to check and treat the uterine cavity.
Blood clotting issues (thrombophilia), immune factors, and chronic endometritis (inflammation of the uterine lining, often silent) can also impair implantation. Targeted tests and treatments exist for each of these. Preimplantation genetic testing (PGT-A) of embryos can rule out chromosomal abnormality as a cause.
The message Dr. Modi gives every patient: failed implantation with good embryos is a question, not a verdict. There are structured investigations to find the cause, and specific treatments to address each one. Most patients go on to achieve a successful pregnancy with the right workup.
Q: What is the ERA test and should I have it?
A: The ERA (Endometrial Receptivity Array) tests the expression of certain genes in the endometrium to identify your personal 'window of implantation'. It's particularly useful after 2 or more failed transfers with good embryos. It requires a mock cycle with biopsy before the treatment transfer.
Q: Can chronic endometritis be treated?
A: Yes. Chronic endometritis is treated with a course of antibiotics. After treatment, a follow-up biopsy confirms resolution. Studies show improved implantation rates after treating chronic endometritis in women with recurrent implantation failure.
Q: If PGT-A tests show embryos are normal, what else could cause failure?
A: If chromosomally normal embryos fail to implant, investigation should focus on endometrial receptivity (ERA), uterine anatomy (hysteroscopy), immune factors, and thrombophilia. Dr. Modi follows a structured protocol for recurrent implantation failure investigation.
The ERA (Endometrial Receptivity Array) tests the expression of certain genes in the endometrium to identify your personal 'window of implantation'. It's particularly useful after 2 or more failed transfers with good embryos. It requires a mock cycle with biopsy before the treatment transfer.
Yes. Chronic endometritis is treated with a course of antibiotics. After treatment, a follow-up biopsy confirms resolution. Studies show improved implantation rates after treating chronic endometritis in women with recurrent implantation failure.
If chromosomally normal embryos fail to implant, investigation should focus on endometrial receptivity (ERA), uterine anatomy (hysteroscopy), immune factors, and thrombophilia. Dr. Modi follows a structured protocol for recurrent implantation failure investigation.
