Marketa Häkkinen: Why Euploid Embryos Still Fail
Marketa Häkkinen, Embryologist at Medi-Gyn Fertility, shared a post on LinkedIn:
“PGT-A is not a guarantee.
Euploid embryo transfer is often presented as the ‘final answer’ in IVF. Yet even with a chromosomally normal embryo, patients may still face:
- Failed implantation
- Biochemical pregnancy
- Miscarriage
PGT-A confirms chromosomal status, but it does not address:
- Endometrial receptivity and implantation dynamics
- Hormonal environment (progesterone, thyroid, insulin resistance)
- Uterine factors (fibroids, polyps, chronic endometritis)
- Immunology and thrombophilia
- Embryo competence beyond chromosomes (mitochondria, epigenetics, sperm DNA fragmentation)
And while tests such as ERA (Endometrial Receptivity Analysis) are widely promoted, current data shows no significant difference in live birth rates between ERA-guided and standard embryo transfers. This raises important questions about cost, clinical value, and patient expectations.
For clinics, two challenges remain:
How do we communicate realistic outcomes to patients after PGT-A?
Where should we direct innovation — lab technology, uterine/endometrial diagnostics, or systemic and lifestyle integration?
Colleagues, what do you see as the most underexplored factor in failed euploid transfers?
Key references:
- Simon C. et al. Endometrial receptivity analysis (ERA) in euploid embryo transfers: randomized clinical trial outcomes. Fertility and Sterility, 2020.
- Rubio C. et al. Impact of ERA-guided embryo transfer on reproductive outcomes in IVF. Reproductive Biomedicine Online, 2021.
- Franasiak JM, Scott RT. Beyond aneuploidy: the complex causes of implantation failure. Fertility and Sterility, 2017.”
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