The Tests & Treatments You Need to Know About After Recurrent Pregnancy Loss or Implantation Failure

If you’ve experienced multiple pregnancy losses or failed embryo transfers, you’ve likely asked yourself:

Why is this happening and what can I do about it?

Unfortunately, many people never receive the full testing or answers they deserve. Some are told to wait until they’ve had three consecutive miscarriages before any tests are ordered. Others undergo IVF without ever learning about additional evaluations that could change their outcome.

This blog post outlines the most important tests and treatments you can request or explore after experiencing recurrent pregnancy loss (RPL) or recurrent implantation failure (RIF) based on an in-depth conversation with Carly from myStoria, a fertility concierge service based in Canada.

Why Standard Testing Isn’t Enough

Many individuals assume doctors will automatically order all the necessary tests. But due to medical guidelines, insurance limitations or lack of updated training, most providers only run basic tests, often skipping crucial insights into your gut, immune system or uterine environment.

You can advocate for more. Here’s what to know.

1. Microbiome Testing

What is the Microbiome?

You have several microbiomes in your body: gut, vaginal and endometrial (uterine). These are ecosystems of good and bad bacteria that need to be in balance. When they’re out of balance (called dysbiosis), issues like infection, inflammation and implantation failure can occur.

Why It Matters

A disrupted vaginal or endometrial microbiome can:

• Prevent implantation
• Trigger immune responses
• Cause chronic inflammation (endometritis)
• Lead to pregnancy loss

How to Test It

• Fertillysis (Home Test): Uses menstrual blood and vaginal swabs. Non-invasive. No biopsy required.
• Emma Test (Biopsy): Clinic-based endometrial microbiome test.
• Alice Test (Biopsy): Detects chronic endometritis via biopsy.

What It Shows

• Lactobacillus levels (good bacteria)
• Presence of pathogens (fungi, viruses, bad bacteria)
• Inflammation markers

Treatment

• Targeted antibiotics
• Oral & vaginal probiotics
• Lifestyle and gut health improvements

2. Autoimmune Testing

What Is Autoimmunity?

Autoimmune disorders cause your immune system to attack your own tissues including embryos. This may cause early miscarriage or implantation failure.

Common Autoimmune Conditions Linked to Fertility Issues

• Lupus
• Rheumatoid arthritis
• Hashimoto’s thyroiditis
• Antiphospholipid Syndrome (APS)

Key Blood Tests to Request

• Full thyroid panel (including thyroid antibodies)
• Antiphospholipid antibodies: Lupus anticoagulant, anticardiolipin antibodies, beta-2 glycoprotein I
• ANA (Anti-nuclear antibodies)
• Rheumatoid factor
• C-reactive protein (CRP) and ESR (inflammation markers)
• Thrombophilia panel (including Factor V Leiden and prothrombin mutations)

Treatment

• Baby aspirin
• Low molecular weight heparin (e.g., Lovenox)
• Steroids (e.g., Prednisone)
• Immunomodulators (e.g., Tacrolimus, Sirolimus)
• IVIG or Intralipid therapy (in specific cases)

3. Sperm Testing Beyond the Basics

Why It Matters

Even if sperm looks fine under a microscope, it can still be fragmented at the DNA level, leading to:

• Failed fertilization
• Poor embryo development
• Miscarriage

DNA Fragmentation Testing

• Measures percentage of sperm with damaged DNA
• Below 15%: excellent
• 15–25%: fair
• 25–50%: poor
• Above 50%: very poor

Treatment Options

• Lifestyle changes: No smoking, no alcohol, avoid extreme heat (saunas, hot tubs etc) & tight clothing
• Antioxidants and vitamins (e.g., CoQ10)
• Specialized medical underwear (e.g., Cool Beans)
• Reduced cycling or laptop heat exposure
• Consultation with a reproductive urologist

4. Immunological Therapies

These are advanced treatments used when immune issues are suspected.

Common Treatments

• LIT (Lymphocyte Immunization Therapy): Uses partner’s white blood cells to modulate the maternal immune system.
• PRP (Platelet-Rich Plasma): Injected into uterus to improve lining and implantation.
• PBMC (Peripheral Blood Mononuclear Cells): Infused into uterus after activation in lab.
• IVIg/SCIg (Intravenous Immunoglobulin or Subcutaneous Immunoglobulin): Calms autoimmunity; considered off-label but promising.
• Intralipid therapy: IV fat emulsion to reduce NK cell activity.
• Low dose steroids: Used to reduce inflammation pre-transfer.
• Tacrolimus/Sirolimus: Immunosuppressants to help prevent rejection of embryo.
• EndomeTrio: Many clinics offer EMMA, ALICE & ERA as a package of 3 tests.

Note:

Many of these treatments are considered experimental and may not be available everywhere. Always consult with a specialist.

5. Receptivity Testing

When Implantation Isn’t Working

If you’ve transferred genetically normal embryos but they haven’t implanted, your uterine environment may not be receptive.

Tests to Consider

• ERA (Endometrial Receptivity Array): Determines the ideal window of implantation.
• Matris Test: Uses ultrasound and AI analysis to assess receptivity score (0–10 scale).
• HCG wash or embryo glue: Additional tools sometimes used in IVF labs.

What to Do Next

If you’ve had 2+ losses or failed transfers, start advocating now:

1. Request a full blood panel (including autoimmune & thyroid)
2. Explore microbiome testing (especially Fertillysis)
3. Get sperm DNA tested if male factor hasn’t been ruled out
4. Ask about receptivity testing and biopsy-based diagnostics
5. Find a clinic or concierge service like myStoria to help interpret results and build a plan

What is myStoria?

myStoria is a Canadian-based fertility support platform that helps people across Canada and the U.S. feel more prepared, empowered, and supported on their journey to parenthood. Whether you're just starting to try, waiting to see a specialist or already navigating treatment, myStoria helps you organize your medical records, track symptoms, and get guidance from trained professionals so you can make informed decisions and advocate for better care. Carly, our concierge director, works one-on-one with users to help interpret results, suggest next steps, and cut through the overwhelm.

You can connect with Carly here:

• Website: https://www.mystoria.com/
• Instagram: https://www.instagram.com/carly_fertilityadvocate/

 

With love and compassion,
Rosie 🌸