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Implantation and the hidden frontier


Implantation takes place well out of sight at the “hidden frontier” inside what might be referred to in Chinese medicine as the “foetal palace or house” i.e. the uterus.


While our understanding of implantation has increased with research, there remains plenty to be better or perhaps not yet understood. It is a complex topic about a process that unfolds far from prying eyes. Can this be summarised in a four-minute read?


For a long time, it has all been about the quality of the egg and its ageing chromosomes, AAA or B+ and so on. The implication being that if one has a ‘quality’ egg / embryo then ‘hey presto’ ….


Yet the only real way to grade an egg or embryo is through the successful delivery of a healthy, normal baby.


It also remains that in the majority of IVF clinics around 50% of the genetically normal embryos (GNE as determined by pre-implantation genetic diagnosis/screening, PGD or PGS) actually implant.


Once that embryo is transferred to the uterus is it cross fingers and hope something happens? It’s a ‘numbers game’ you might hear. An endometrial scratch? Perhaps glue?


This exasperating situation might be occurring for the IVF patient who, despite creating “good looking embryos” fails to establish a viable pregnancy.


So, what is going on with the large number of GNE which DON’T implant? Can we still blame lack of implantation on simply poor egg or poor embryo quality?


In some cases, yes – yet a myriad of factors remain that influence this situation, as in all healthcare. This in itself is a conversation beyond the parameters of this blog.


So, what do we currently understand makes the endometrium more “receptive” and how may these may be influenced to help get the house in order’ to welcome the ‘guest, to support those genetically normal embryos gain a foothold and become a viable pregnancy.……….


The structure of the lining


The lining of the womb (stratum functionalis) must be adequately prepared for pregnancy (decidualised) before it can recognise and accept an embryo.


Structural impediments


There must not be any structural impediments to implantation, such as uterine abnormalities, polyps, fibroids, retained products from an earlier miscarriage or adenomyosis. We need smooth contours.


Good blood supply to the deeper layers of the endometrium


The stratum basalis consists of permanent stromal tissue and deep ends of the uterine glands. These tissues remain through each cycle and serve as sources for cells during regrowth of the superficial stratum functionalis.


A calm and relaxed uterus


Frequency of uterine contractions increase around the time of ovulation and diminish by the time of implantation. Some cramping is not unusual for women having an embryo transfer in an IVF cycle. This may be an issue as the more contractions after embryo transfer, the lower the rate of successful implantation.


Thick and juicy lining.


Studies have shown that the lining needs to be 6 or more millimetres for successful implantation.


Optimal hormone levels


Oestrogen primes and stimulates the growth of a receptive lining while progesterone maintains it and eases the contractility of the uterus during the implantation window.


In some IVF cycles, the levels of these hormones are not ideal hence why some IVF clinics prefer to transfer those defrosted frozen embryos in a natural cycle into a natural environment.


A friendly immune environment


This is a complex and fascinating topic, the scope of which reaches beyond this read. Autoimmune disease, or subtle imbalances in the immune regulation of the uterine environment can have a large impact on an embryo’s attempts to implant.


A fresh food diet:


Maternal diet affects the nutrient composition of fluid in the womb and thus may aid in the development of nutritional interventions to support the very earliest stages of

pregnancy.

So, what more can I do to assist these requirements and help get that house in order to welcome the guest?


Your menstrual cycle


Since the Song Dynasty (960 till 1279), Chinese medicine doctors have understood that to have a regular problem free menstrual cycle increased the chances of conception. This approach remains a pillar in the (and my) management of conception issues now and why many of the formulas and treatment approaches in Chinese medicine are about regulating the cycle.


Structural impediments inside the uterus.


A conversation with your reproductive specialist is required to ascertain if there are polyps or fibroids affecting the lining or other internal structural impediments like endometriosis.


Keep in mind that in large amounts, caffeine can aggravate uterine fibroids as it can increase oestrogen production. It also has other potential implications. (there's that diet again).


Blood flow to the uterus.


Walking and fertility yoga are two ways (not the only ways) to promote circulation and improve strength and flexibility of the muscles surrounding the uterus. The Fertility Institute has some tips for exercise choices.


Further, some small studies on infertile women have shown an increase in blood flow in the uterine artery after electro-stimulation of acupuncture points on the abdomen. Research continues here to clarify this.


Stress and the immune system


We know that stress can affect the immune system, elevating levels of activated T cells in the uterine lining, reducing implantation rates.


There are many ways to assist with stress management and anxiety. To start, try a few to find relaxation techniques that work for you. From prayer to painting, it's about what works for you.


Acupuncture is one many patients choose and this in itself, may be one way it helps to support women having difficulty conceiving.


Improving your diet


You've heard it before , "you are what you eat" and fresh is best! This research shows what you eat actually directly influences the environment of the uterine lining and implantation.


Read more detail HERE


In summary:


This topic is hugely complex and diverse. I trust you have gleaned a snippet or two of information that may assist you in your understanding of some of the processes and pursuit of pregnancy. Should you be interested in more reading or detail feel free to contact me or put forward a topic to be explored.



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