Unraveling the Mystery: Why Top-Quality Embryos Don't Always Implant?
June 28, 2023

Patients understandably get very frustrated when their top quality embryo doesn't implant in what looks like a perfect endometrium and they demand answers from their doctor. But the reality is just that this is as frustrating for doctors as it is for patients because the fact remains that embryo implantation is a black box area which we don't understand too much about. And it’s because we don't understand enough about it, we offer so many different confusing options for “treating” what is called failed implantation. These include things like trying acupuncture or changing your lifestyle or giving additional medicines, such as low molecular weight heparin, immune therapy, or increasing the progesterone dose. And of course, there's always “ modern science “ which comes to the rescue, so many doctors will offer additional “advanced” sophisticated and expensive interventions, such as embryo biopsies, to check if the embryo is “ genetically normal “ ( PGS), and tests like endometrium receptivity assays. But the reality is there's nothing that we can do to affect embryo implantation - nothing which you can do, and nothing which your doctor can do either. Now this is both good and bad. It's good in the sense that if your embryo doesn’t implant, you don't need to blame yourself because you've done everything humanly possible and not left any stone unturned. It’s bad because it's very scary to realize that this is a biological process that no one can influence. You need to learn to be philosophical and stoic about this, and this ignorance teaches good doctors a lot of humility. However, most doctors aren't very good at being humble, and patients really don't want doctors to tell them - Look, I'm sorry, I can't do anything more – it’s now in God’s hands. They want definitive answers and crave certainty from their doctors. Part of the problem is many doctors will take advantage of the desperation and frustration that patients who have failed IVF cycles go through, and come up with all kinds of solutions for what they can do differently the next time to increase the chances of success. Many unscrupulous doctors will even start suggesting that the patient consider using donor eggs, donor sperm, donor embryos, or surrogacy - not because this actually increases the chances of the patient getting pregnant, but because it increases the amount of money that the doctor can earn from these patients. So please don't let anyone take you for a ride. You need to do your own homework and your research. You need to understand that once your embryo is inside your uterus it's safe and secure. It's where it was designed to be and there's very little that anyone can do to influence the outcome of embryo implantation. So you just need to accept this and learn to be patient. It's only when you have unrealistic expectations that you start becoming unhappy. The good news is that once you have been through a failed IVF cycle, often doing the second one is much easier, because you've been there and done that, and you have peace of mind that you've done everything possible. The secret is to find a kind and empathetic doctor, who will be honest with you, and who will transfer a single top-quality blastocyst until you get pregnant.

Frozen transfers are much easier because the medicines are given orally and vaginally so that you don't require any injections at all - and you don't even need to take leave from work.

If have failed an IVF cycle and are not sure what to do next please feel free to email me at and I'll be happy to give you my suggestions. But please make sure that you send me photographs of your embryos because this is critical information that helps me to know whether you've received good-quality treatment or not. You can see what embryos should look like at

Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.