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For patients with negative pregnancy tests

Oak Clinic: Our approach when success is hard to reach

There are several known potential issues to discuss and explore.

1. Fertilized egg condition

The ability of eggs to be collected and fertilized successfully may account for up to 70% of the progress toward success.
Therefore, the best way of moving toward success is to continue collecting and fertilizing eggs.
Even a low-grade embryo (but which is good enough to freeze) may very well implant and become a healthy child, so never get distressed by the grade of embryos.
The biggest factor in viability is chromosomes, which cannot be seen with the naked eye, only guessed at.
Sometimes a “perfect” grade embryo may have chromosomal abnormalities or a lower grade embryo may have excellent chromosomes. It cannot be seen only by looking.
There are many possible problems, but the impact of age is strong.

Collecting eggs sooner than later is therefore the most important step to take.
It is OK to delay transfer in order to collect more eggs sooner, as the results of age on transfer are less severe than the results of age on egg health.

Chromosomes can be examined through a special test.

2. Endometrium condition

Tests to know the condition: IFCE [HF (hysteroscopy) + endometrial biopsy], ERA, ALICE, EMMA1)

1)Physical factors: we can see them with hysteroscopy
●Uterine fibroids may be compressing the endometrium.
●There may be hydrosalpinx or abscess, and implantation may be hindered by the flow of secretions from the fallopian tubes to the uterus.
●Menstrual blood may accumulate in a scarred part of the incision after cesarean section and inhibit implantation.
●There may be a fibroid or polyp in the endometrium.

2)Qualitative issues: IFCE, ERA, EMMA, ALICE
●Chronic endometritis (prone to inflammation): IFCE [HF (hysteroscopy) + endometrial biopsy]
●Implantation window may out of alignment: ERA (Endometrial Implantation Ability Test)
・Bacterial flora (intrauterine flora) may be not well balanced: ALICE (infectious chronic endometritis test)
●Lactic acid bacteria ratio may be troublesome: EMMA (endometrial microbiome test)

Endometrial biopsies have been reported to increase implantation rates slightly, but cannot be repeated frequently due to the risk of intrauterine adhesions.
Regarding the diagnosis of EMMA and ALICE, they are less conclusive than other examinations, but those who wish to have a test can take it.

3. Personal Environment

Inspections used to consider personal environment are mostly blood tests and tests related to implantation failure.

Implantation failure may correspond to the repetition of very early miscarriage, suggesting that antibodies involved in infertility may themselves be causes of implantation failure.
For example, anti-cardiolipin β2GPI antibody is known to cause miscarriage.
Abnormalities in the coagulation system (prone to blood clots) occur, resulting in a miscarriage.
Ultimately, there are numerous possible causes of implantation failure, however, and many items which are suggested to be related.

Implantation failure tests performed at this hospital can be divided into the following main categories.
1. Those that cause abnormalities in the coagulation system (examination of recurrent pregnancy loss – test categories ① and ②)
2. Immune function is too strong (recurrent pregnancy loss test category ③ - weekday only, by appointment)
3. Chromosome test of couple (recurrent pregnancy loss test category ④ - weekday only, by appointment)
4. Nutrition problems such as vitamin D (test for recurrent pregnancy loss category ⑤)

Depending on the result, we will consult with you and propose treatment for correction.
As a rule of thumb, we often propose an implantation failure test after 2-3 implantation failure events.
However, if the chances of a transplant are low, such as in old age or with ovarian dysfunction, we may make a proposal before the first attempted embryo transfer.
Not all items are definitely related or a cause, but we can do our best to make the environment as good as possible.
Some items are often positive, and if they are positive, you will have to take medications, injections, and related blood tests before giving birth to correct them.

Since there is a possibility of excessive medical treatment in the case of positive results, we will propose tests while considering the balance.
However, if a patient truly wishes to inspect all items before the first attempted embryo transfer, we can accommodate that wish.

Oak Clinic Group

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