Implantation failure treatments (or how to increase the chances of implantation success) vary according to why implantation is an issue. We have listed 14 reasons for implantation failure and the treatments that match these. We also explore the connection between the six morefertile Fertility Profiles and the likelihood of difficulties with implantation and how to change those odds.

Standard Treatments for Endometrial Disorders

These treatments revolve around improving the attachment bonds on the surface of the endometrium. Implantation is a complex process, and the proteins on the womb surface change dramatically across the month, which alters how it behaves.

1. Clomiphene citrate (Clomid) or gonadotrophins such as FSH or hCG if there’s evidence that low FSH or oestradiol levels are causing luteal phase defects and implantation failure
2. Letrozole (an aromatase inhibitor) may be prescribed where there’s evidence of a lack of endometrial ανβ3 integrin expression ^xiv
3. Heparin or aspirin (75 mg per day) may be prescribed for low uterine artery blood flow or thrombophilia
4. Tubal surgery to remove hydrosalpinges by laparoscopy is recommended as it significantly increases live birth and pregnancy rates in women with hydrosalpinges before IVF (compared to no treatment) ^xv
5. Where there’s evidence of raised uterine immunological activity, Humira, IVIg, corticosteroids, or LIT may be the treatment of choice

PFPs and implantation failure

The personal fertility profiles (PFPs) have common themes that relate to problems with implantation, and there are specific treatments for implantation failure with herbal medicine, and approaches to follow:

• Fluids: the issue here is usually thickened fluids or mucus on the endometrial surface, making implantation difficult. These women will often get excessive or thick discharges, changes to diet are essential, and herbs are effective in improving the situation
• Flow: it’s possible that scarring or other physical obstructions are preventing implantation, and ultrasound or hysteroscopy can check the structure of the womb. Herbal medicine or acupuncture can help regulate hormones, the flow of blood during the period, and cycle dynamics
• Cold: low progesterone levels and low temperatures in the luteal phase are the common issues for this PFP. A lack of nutrients in the luteal phase may reduce the chances of implantation, so progesterone levels are worth checking, as are changes to diet, exercise and medicinal herbs to increase vitality
• Blood, Energy and Hot: These PFPs tend to involve womb linings that lack depth and attachment vitality. These PFPs are advised to focus on immune balance and improving energy levels, as explained in the different PFP advice.

Self-help for implantation failure

The best approach will depend on the individual and the nature of their problem, so follow the advice for your Fertility Profile! However, herbal medicine, acupuncture, changes to diet and supplements are known to help.

Diet: A whole-food rich diet tailored to the fertility profile of the individual is the best way forward, and other factors to consider include:

• Vitamin E, L-arginine and sildenafil citrate improves the thickness of the endometrium where the functional layer is too thin for successful implantation ^xvi
• Vitamin C improves hormone levels and increases fertility in some women with luteal phase defects, ^xvii and in one study, 25% of the women who received vitamin C got pregnant in 6 months compared to 11% in the placebo group. Foods rich in vitamin C include papaya, bell peppers, broccoli, Brussels sprouts, strawberries and oranges. Vitamin C is cooling, so some caution is needed for Cold PFPs!
• Essential fatty acids (EFAs) are necessary for hormone production, but many people are chronically low in EFA, especially omega 3. Foods rich in EFAs include walnuts, salmon, sardines, halibut, shrimp, scallops, liver, eggs and flaxseeds
• Green leafy vegetables are rich in the B vitamins, which are essential for proper hormonal balance
• Antioxidants inhibit damage to cells, and recent studies have found that oxidative damage may cause implantation failure, and women with recurrent miscarriages have significantly lower levels of antioxidants than other women. Antioxidants have many benefits to fertility (particularly reducing potential oxidative damage to DNA) that we recommend that every couple consider them part of their fertility program

Treatments according to the 14 causes of implantation failure

1. Abnormal structure of the endometrial lining

Abnormalities of the womb lining are found in up to 25% of repeated implantation failure cases on a second examination. The conventional option is corrective surgery with hysteroscopy to remove significant anomalies, increasing a woman’s fertility. ^[i]

Hormonal balance and blood flow are crucial aspects of fibroid growth and shrinkage. Progesterone supplements increase fibroid growth 3x compared to those that contain progesterone and estrogen.  There’s good evidence that both acupuncture and herbal medicines can help resolve abnormal structures in the womb. ^[ii] A nationwide population-based study of patients with dysfunctional uterine bleeding (often due to uterine abnormalities) in Taiwan found almost 90% of patients used herbal medicine to improve their condition. ^[iii]

2. The endometrium is too thin

An endometrium that’s less than 7mm thick is unable to support implantation and pregnancy, as 8mm is considered the minimum depth for realistic chances of success. The conventional treatment option is to supplement estrogen levels to stimulate greater endometrial growth in the follicular phase. A new approach is to treat with platelet-rich plasma, and in a trial study, the womb lining became thicker, and 50% of the women became pregnant. ^[iv]

Regarding morefertile PFPs, this issue is most commonly an issue for Blood, Energy or Hot PFPs. The appropriate lifestyle, diet (and herbal) approaches are part of the PFP support advice, but doing these will help:

• Stop smoking and drinking alcohol
• Be physically active to increase blood flow in the pelvis
• Follow a low sugar and carbohydrate diet as diabetes is a risk factor

3. Poor blood flow

1. The most critical issue for uterine blood flow is blood pressure
2. Being in pain reduces uterine blood pressure
3. Anaesthetics may also reduce bloodflow
4. The immune conditions of anti-phospholipid antibodies and anti-nuclear antibodies are known to reduce circulation to the womb

Balance/Flow Fertility Profile women are more prone to poor circulation, and herbal combinations can increase circulation, reduce the chances of clotting and improve the quality of blood.

4. Hydrosalpinx

A hydrosalpinx is such a gross distortion of a Fallopian tube that it can, and the tube’s altered shape significantly increases the chances of ectopic pregnancy. If one tube has been affected, the toxic fluid in it can also discharge into the uterus, creating a hostile womb environment that makes implantation much less likely should an embryo arrive from the other, healthy tube. The only realistic treatment is the surgical removal of the affected tube and IVF treatment if both tubes are affected.

5. Endometrial development dysfunction

The changes needed for the “window of implantation” rely on the autonomic nervous system (ANS) as it regulates the transit and function within organs. The most significant factor that affects the balance of the ANS is our response to stress and relaxation. Our advice for all women trying to get pregnant is to focus on improving the health of their Fertility Profile and following the advice within it for stress management.

6. Genetic abnormalities

There are no treatments for aneuploidy conditions, but it is possible to reduce DNA fragmentation rates with changes to lifestyle, the addition of supplements and herbal combinations. These are usually aimed at men as it’s easier to see when sperm have DNA fragmentation problems, but the same principles apply to eggs and are important parts of the morefertile PFP support packages.

7. Heightened immune response

Immune conditions such as elevated natural killer cells involve the mother’s immune system removing embryo cells and causing implantation failure or a miscarriage. Both sides of the immune system need to respond to pregnancy to succeed, but an overly aggressive system can immunise against pregnancy.

There are a variety of immune conditions that reduce the chances of pregnancy; conventional treatments involve immune suppressants and steroids. However, herbal options are viable for many of them, especially when combined with lifestyle and diet changes that raise general health.

8. The parents’ immune systems are too similar

The immune system relies on the ability to distinguish “self” from “non-self”, with HLA-DQα markers on cells indicating “self” to the immune system. When the two partners have exactly the same HLA-DQα markers, their embryos display “self” to the mother’s immune system.

The normal immune response to the embryo doesn’t occur, or the adaptation to accommodate pregnancy. Without changes in the structure of the womb and blood supply, the pregnancy can’t progress, and unfortunately, no treatment options exist except donor sperm or egg for these couples.

9. Uneven Endometrium

An uneven endometrial lining is a significant cause of implantation failure and is often associated with scanty or very heavy periods. It’s essential that women with dysfunctional uterine bleeding have it diagnosed fully because once the cause has been found, it makes deciding on treatment much easier and effective:

• All significant physical structures can be surgically removed
• Infections can be treated with antibiotics
• Simple or complex atypical endometrial hyperplasia can be treated with hormone therapy
• Changes to diet and lifestyle can make significant improvements
• Herbal combinations or acupuncture improve the balance of the ANS and the regularity of the cycle

10. Excessive blood clotting

Thrombophilia is a significant issue for women with RIF or “unexplained infertility” and is found more often in them than in the general population. ^vii Testing is essential to determine the cause and correct treatment option, and Balance/Flow FPs are most at risk of thrombophilia. Conventional treatment relies on blood thinners, usually Aspirin or Heparin, and herbal therapies are effective for APAs and reduce the chances of clotting.

11. High “aromatase” levels

When women who’ve had two unsuccessful IVF treatments are given a third (frozen) cycle with a combination of a GnRH agonist and an aromatase inhibitor (Letrozole), it increases pregnancy and birth rates: ^[v]

This data is from recent trials and may not be available at all clinics, but Letrozole is the treatment of choice. As some antibiotics and tranquilisers raise aromatase levels, check with your MD/GP if you’re taking these medications. Psychological stress, alcohol, diet and inflammation also raise aromatase levels; follow the advice for your morefertile FPP to improve homeostatic balance and increase fertility.

12. Low “integrin” levels

Although low-dose aspirin may increase integrin activity, there isn’t a precise conventional treatment for low integrin levels. ^[vi] Integrin levels are part of homeostatic balance and are clearly related to uterine health and progesterone levels. Following the lifestyle and diet advice for your morefertile FPP will improve these factors.

13. Hormones used in ART

These factors need to be discussed with the fertility clinic.

14. Abnormal uterine microbiome

Testing and treatment of the uterine microbiome are available from specialist suppliers, and they also have tests and solutions for abnormal semen microbiome as the transfer of bacteria from the vagina to the penis and vice versa are inevitable during sex.

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