If you have only 1 or 2 euploid (chromosomally normal) embryos, we understand how invaluable and irreplaceable they are. In these cases, we take extra precautions to ensure the uterine environment is optimal before moving forward with a transfer.
Even with a perfect embryo, implantation can fail if the uterus isn’t receptive. That’s why we perform a thorough evaluation to identify and address any hidden issues that could interfere with implantation.
The Tests We May Recommend:
1. CD138 – Chronic Endometritis Biopsy
- What it checks: Presence of plasma cells in the uterine lining, which indicates chronic inflammation or infection.
- Why it matters: Chronic endometritis is often silent (no symptoms) but may disrupt embryo implantation or increase miscarriage risk.
- Treatment: Usually short-course antibiotics.
2. BCL6 – Endometrial Receptivity and Inflammation
- What it checks: Elevated BCL6 protein levels linked to inflammation and progesterone resistance, often seen in women with endometriosis (even if asymptomatic).
- Why it matters: High BCL6 can reduce endometrial receptivity, lowering the chances of a successful pregnancy.
- Treatment: Hormonal suppression (e.g., GnRH agonists or birth control) may improve the uterine environment.
3. EMMA/ALICE – Endometrial Microbiome Analysis
- What it checks:
- EMMA: Evaluates beneficial vs. harmful bacteria in the uterus.
- ALICE: Detects pathogenic bacteria that may cause inflammation or infection.
- Why it matters: A healthy microbiome is crucial for implantation. An imbalance may affect embryo acceptance.
- Treatment: Targeted antibiotics, probiotics, or prebiotics based on results.
4. ERA – Endometrial Receptivity Analysis
- What it checks: Determines the exact timing when your uterus is most receptive (the “implantation window”).
- Why it matters: About 30% of women have a displaced implantation window, meaning standard timing may miss the optimal day.
- Treatment: Customizes your transfer to match your personal window of receptivity.
Our Goal: Maximize Your chances with minimal risk
With only one or two embryos available, we want to give each embryo the best possible chance to implant and develop into a healthy pregnancy.
These tests:
- Identify invisible barriers to success
- Allow us to individualize your care
- Reduce the risk of using a precious embryo in a suboptimal environment
Final Thoughts
You’ve come so far — and every embryo matters. These evaluations are part of a careful and evidence-based approach to help you reach your goal of a healthy pregnancy. If testing reveals an issue, we’ll treat it proactively, rather than finding out after a failed transfer.
Let us know if you’d like to review any of these results or talk about next steps.
