Possible causes of failed implantations and difficulty conceiving

Dear Professor Winston,

I am 30 years old. I have been trying to conceive for 3 years following a 7 week miscarriage. My husband and I have endured 6 months of clomid (although I have a regular cycle). 3 x rounds of IUI and now we are in the middle of our first round of IVF.
23 eggs collected, approx. 50% fertilised (no ISCI required) , and I ended up with 4 high quality embryos. Three were frozen and one transferred which did not work. A few months later I had a double FET and again, no pregnancy. I have pushed for some blood tests to look for possible causes of the failed implantations and difficulty conceiving. I am still awaiting the results (10 weeks later) and then I will have my final NHS funded frozen embryo transfer.

Is there something I am missing? I’m wondering If I should ask about laparoscopy as implantation to be the stage that isn’t working? I had to ask for further tests into failed implantation as the consultant I last saw didn’t seem to know about my miscarriage and the fact my previous failed transfer was a double one. I am worried someone isn’t connecting the dots so I am torn between letting the experts do their job or pushing what I feel I need looking at.

Best wishes,


Dear C.

Nearly all your questions have been answered previously on this website. I think you have to understand that immediate success from a single fresh IVF cycle followed by transfer of frozen embryos is not the usual outcome. And as I have repeatedly explained, there is no such thing as a ‘high-quality embryo”. Inspection of the eggs or embryos down a microscope do not give a proper assessment of their capability of further development and pregnancy. The light microscope that is used in an IVF laboratory is a relatively primitive instrument which cannot assess fine detail, the molecular structure of the cells, or any of the physiological potential for further development.

The one fresh cycle you have had resulted in 23 eggs being collected. The collection of so many eggs may indicate that your ovaries were responding to stimulation too much. This is likely to affect how the eggs might mature after fertilisation and the capacity of any embryo that is produced, fresh or frozen, to continue growth to implant and become a fetus.

Your email also gives me some disquiet because it is unclear how well you have been investigated and why you needed IVF in the first place. Perhaps you have had more tests than you mention. But whatever the case, if you are intending to have another fresh IVF cycle, a very careful adjustment of the dose of drugs given to stimulate your ovaries may be helpful.

Best wishes

Robert Winston