Ms. Huyen experienced unexplained infertility. Her first in vitro fertilization (IVF) attempt with embryo transfer failed, and the second resulted in an ectopic pregnancy, requiring the removal of her right fallopian tube.

After a five-year hiatus from treatment, Ms. Huyen was diagnosed with uterine polyps and endometrial inflammation. She received treatment to stabilize these conditions before subsequent embryo transfers, but two more attempts were unsuccessful. The couple continued to save money for further treatment, but six additional embryo transfers also failed.

The couple then sought care at the Center for Reproductive Assistance, Tam Anh General Hospital Hanoi (IVF Tam Anh). A hysterosalpingogram revealed a filling defect in the uterine cavity, suggesting an abnormality affecting embryo implantation. Associate Professor, Doctor Le Hoang, Director of IVF Tam Anh, prescribed hysteroscopy combined with laparoscopy to identify the cause of the repeated embryo transfer failures. The results showed Ms. Huyen had multiple small polyps scattered throughout her uterine cavity. This condition, an excessive proliferation of the endometrium, can deform the uterine cavity, hindering embryo attachment and implantation. If pregnancy occurs, polyps can increase the risk of early miscarriage if not completely removed.

Doctors surgically removed the uterine lesions for Ms. Huyen and performed a comprehensive assessment of the couple's fertility. Her ovarian reserve had significantly declined due to age. The medical team developed a personalized ovarian stimulation protocol, successfully retrieving 8 mature oocytes.

Associate Professor Le Hoang performs oocyte retrieval for a patient. Photo: IVF Tam Anh

The husband had a low sperm count, poor motility, and a high rate of abnormal morphology. Embryologists performed sperm washing and selected the best sperm based on morphology and motility. They then utilized the short-tail sperm spinning technique combined with intracytoplasmic sperm injection (HN-ICSI) to create embryos. After culturing the embryos in an Embryoscope incubator system integrated with artificial intelligence (AI), they obtained five day-5 embryos and one day-6 embryo.

Given the couple's advanced age, there was a high risk of embryos carrying chromosomal abnormalities. They were advised to undergo preimplantation genetic testing (PGT). Results revealed two day-5 embryos with chromosomal abnormalities, which had to be discarded.

To increase the chance of success in patients with a history of recurrent implantation failure, doctors performed endometrial scratching before the embryo transfer cycle. This procedure creates small mechanical lesions on the endometrial lining to stimulate natural regeneration, enhance endometrial receptivity, and improve synchronization between embryo development and the uterine lining's "implantation window."

When optimal conditions were met, doctors transferred one day-5 embryo into the uterine cavity, and Ms. Huyen became pregnant immediately. She was closely monitored and received thromboprophylaxis medication to reduce risks throughout her pregnancy. In late May, Ms. Huyen delivered a baby girl weighing 3 kg via cesarean section. The remaining healthy embryos were cryopreserved for the couple to have more children in the future.

Repeated embryo transfer failures not only cause psychological stress and prolong treatment but also significantly increase costs for infertile patients. In many cases, small lesions like endometrial polyps, chronic endometritis, or a lack of synchronization between the embryo and the uterine lining can prevent even good quality embryos from implanting.

According to Associate Professor Hoang, about 20% of infertility cases are related to abnormalities in the uterine cavity that are difficult to detect through routine examinations or ultrasound. Hysteroscopy allows direct visualization of the uterine cavity, detecting small lesions that other methods might miss.

Therefore, patients experiencing multiple failed embryo transfers, recurrent miscarriages, or prolonged unexplained infertility should seek early examination. Doctors will conduct a comprehensive assessment, evaluating embryo quality, endometrial status, anatomical abnormalities within the uterine cavity, and hormonal, immunological, and underlying health factors in women. This approach allows doctors to develop personalized treatment protocols, helping patients achieve pregnancy sooner, have healthy children, and reduce costs.

Trinh Mai