In-Vitro Fertilization (IVF) is a complex process that has seen significant advances in technology over the years. One emerging add-on is known as EmbryoGlue. This technique is used in the final step of an IVF treatment protocol, the embryo transfer, to improve an embryo’s probability of implanting.
The final and critical step of IVF treatment is the embryo transfer, where a fertilized egg is transferred into the uterus through a catheter. Here, a good-quality embryo and a receptive uterine lining (endometrium) can produce successful implantation and pregnancy, like planting a seed into the soil. However, if the embryo is genetically abnormal or if the endometrium does not provide a suitable environment for the embryo to implant, a failed implantation can result.
Many available “add-on” techniques to the IVF treatment protocol can be prescribed to give an embryo the best possible chance of implanting. Some methods aid the embryo itself, such as assisted hatching, while others involve improving the endometrial environment, like endometrial scratching.
Firstly, EmbryoGlue is not an actual glue! It is made from a substance called Hyaluronan, or hyaluronic acid. It is a carbohydrate naturally produced by the body, and while it can be found in every cell and tissue, it is most abundant in the skin, joints, and eyes1. Hyaluronic acid functions to lubricate our joints, deliver nutrients to cells and hold moisture1.
In addition to these locations, hyaluronic acid is also present within the fallopian tubes, uterus, and cervix1. The substance helps to produce a thicker mucus, especially around ovulation1. Notably, right before implantation, the uterus produces an abundance of hyaluronic acid. It is thought that this substance helps to encourage the development of an embryo after fertilization but before implantation1. After implantation occurs, hyaluronan levels will fall back to normal.
This idea led researchers to consider that incorporating Hyaluronic Acid into IVF treatment protocols could aid embryo implantation due to its thick and sticky properties. Additionally, it could better mimic a real uterine environment while growing the embryo in the lab.
In an IVF treatment, a newly created embryo is grown in a complex liquid solution called a cell culture media. This media is full of nutrients that a developing embryo needs to survive and develop. If EmbryoGlue is used in the treatment, it will replace the traditional media. EmbryoGlue contains these essential nutrients and includes a high concentration of hyaluronic acid to mirror the high levels seen in the uterus during implantation2. After implantation, Hyaluronan’s sticky nature helps the embryo better adhere to the endometrium, minimizing movement to increase chances of implantation2.
When EmbryoGlue initially became available for clinical use in 2003, it was met with conflicting scientific results on whether it truly improved implantation rates. Of research available so far, most studies have found that hyaluronic acid improved implantation and pregnancy rates3,4,5,6,7,8, but some found that the use of EmbryoGlue did not produce significantly higher implantation rates9,10. However, studies concluded that EmbryoGlue is a safe addition that does not pose a risk to the parent or the child born from the treatment.
The Human Fertilisation & Embryology Authority (HFEA) lists EmbryoGlue as “Amber” on its traffic-light system of rating fertility add-ons. This amber rating reflects that while the treatment is safe for both parent and child, there is conflicting scientific evidence as to whether it truly improves implantation rates.
At Anova, our doctors have had success with EmbryoGlue, especially in patients with recurrent implantation failure (RIF) or those with naturally lower levels of hyaluronic acid due to age. In Ontario, it is important to note that fertility add-ons such as EmbryoGlue are not covered by the Ontario Health Insurance Plan (OHIP) and require an additional cost. Therefore, we feel that it is essential to provide our patients with all available information to make an informed decision on the use of EmbryoGlue in their IVF treatment.
EmbryoGlue is not required for all patients undergoing IVF treatments. Instead, this treatment is only recommended to patients based on their medical and fertility treatment cycle history. It is important to speak to your doctor to determine whether EmbryoGlue could benefit your fertility journey.
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Chloe Graham (she/her)
Doctoral Student (University of Guelph, Biomedical Sciences)
Chloe is a Doctoral Student in Biomedical Sciences at the University of Guelph, who also works as a patient coordinator at Anova Fertility.
At Anova, she educates patients through creating online resources, manages patient flow and assists with administrative functions. Before joining our team, Chloe advocated for women’s health and reproductive rights as an executive member of Oxfam at Guelph, local branch of the international anti-poverty organization.
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