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One of the most frustrating outcomes of an IVF cycle is failed implantation. Everything seems to be going well - there are lots of eggs and embryos, and the doctor is happy with the embryo quality, the embryo transfer and the endometrial lining.
Patients start thinking of themselves as being pregnant when their embryos have been transferred - and many refer to their embryos as their babies ! This is why when the HCG test is negative, they are devastated.
The failed cycle
When the cycle fails, and their hopes come crashing down, patients demand answers. The doctor labels this as being "implantation failure" - and starts manufacturing creative reasons as to why the embryos did not implant. He runs lots of tests - and offers lots of suggestions as to what they can do differently the next time, to improve the chances of success.
Uterus at fault
Most patients understand that even a perfect IVF cycle has a success rate of less than 50%, and most are mature enough to repeat the cycle again. However, when they encounter repeated failure, they start thinking about Plan B. Many will change the clinic, but when the same story plays itself out again, they start believing that the problem lies within their uterus, and they should consider surrogacy as a treatment option,
This is quite a logical assumption. After all, if the transfer of top quality embryos into the uterus has failed to give them a baby, doesn't this "prove" that their uterus has rejected the embryo ? And if so, then isn't it logical to assume that the best solution is to do surrogacy.
After all, a surrogate has proven her fertility, and if I transfer my good-quality embryos into her good-quality uterus, then of course she will get pregnant and I will have my much longed-for baby ! This is extremely logical thinking - but is completely flawed.
A genetic problem
The reason for this is the fact that most good-quality embryos do not implant because they have a genetic problem ( which we still cannot identify with today's technology), even though the embryo looks perfect. This is the reason why human reproduction is so inefficient - and why even fertile couples take time to make a baby !
If a perfect embryo fails to implant in a perfect uterus, 9 times out of 10, the problem is with the embryo, rather than the uterus. A simple rule in medicine states when you hear hoofs, you should think of horses and not zebras ! This is why surrogacy is not the best treatment option for women who have failed multiple IVF cycles.
Most of these women have a completely normal uterus; and if they transfer embryos created using donor eggs from a healthy young women into them, their chances of having a baby would be much higher, as compared to using a surrogate ! The uterus is an immunologically privileged site, which cannot reject embryos, no matter where they come from.