Management strategies following implantation failure of euploid embryos

Abstract

BackgroundEuploid blastocyst implantation failure may result from embryonic factors undetectable by preimplantation genetic testing for aneuploidy (PGT‐A); however, various nonembryonic factors can also intricately interfere with implantation. This review seeks to clarify evidence‐based testing and treatments for implantation failure after euploid embryo transfer.MethodsWe conducted a review of the literature on implantation failure after euploid embryo transfer or multiple embryo transfer cycles, which mainly included systematic reviews and meta‐analyses.ResultsThe recommended tests for implantation failure include (1) hysteroscopy, (2) endometrial CD138 immunohistochemistry and bacterial culture, (3) serum 25‐hydroxyvitamin D3, and (4) thrombophilia screening. Based on diagnostic findings, the following treatments have been recommended: (1) antibiotics for chronic endometritis, (2) vitamin D replacement, (3) lifestyle modification, and (4) low‐dose aspirin starting from the postimplantation period for thrombophilia. Moreover, frozen–thawed single euploid blastocyst transfer using assisted hatching and hyaluronan‐enriched transfer medium may support embryo implantation.ConclusionTo ensure a successful pregnancy in subsequent embryo transfers, simple, inexpensive, and evidence‐based tests and treatments should be selected.