Embryo implantation is a still a "black box" as far as medical science is concerned, because we can't predict or control which embryos will implant. This is hardly surprising, given that it's a complex biological process, which involves an intricate interchange of signals between the embryo and the uterine lining.
There are lots of factors which determine success, and while we know what some of these are, many are still beyond our comprehension.
For example, we know that a top quality embryo has a better chance of resulting in a pregnancy, as compared to a poor quality embryo.
However, we also know that not every perfect embryo transferred into a perfect endometrium will implant! This causes a lot of heartbreak and distress, but this is because there are many other factors which determine success, which we don't know enough about ! These include: genetic factors; epigenetic factors; and immunological factors , all of which have still not been analysed in sufficient detail.
At present, we are forced to include these under the rubric of "luck", "karma" and "fate" - which aren't very accurate or helpful ! Patients want more accuracy from their doctors !
Thus, if a patient does not get pregnant after the transfer of a top quality embryo into a receptive endometrium, we attribute this to "bad luck". Often, all we can do is repeat the cycle until her luck changes !
It's partly because there is so much about IVF that we don't understand that both IVF specialists and patients are so easily swayed by anecdotal case studies. This is why there are still so many useless and unproven "treatments" which plague IVF today, including: endometrial scratching; endometrial receptivity assays; PGS ( preimplantation genetic screening); and treatment with "stem cells". While these are very profitable for the clinic to offer, the truth is that they haven't been shown to improve clinical pregnancy rates in clinical studies.
This is why research and development is so important. However, it's not fair to use patients as guinea pigs - and to charge them for expensive and unproven "treatments" under the guise of their being the "latest technology" .
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