Replay: Embryo Glue — Should You Use It? (New Evidence Next Week)

This is a replay of our 2023 episode on embryo glue. The discussion reflects the evidence available at that time.

A lot has changed since this episode was first released. Listen again — because next week we’ll be back with a brand-new episode covering newer data and updated evidence you won’t want to miss.

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Embryo Glue: Is it a glue? Does it help? Should you use it?

In this episode we discuss the what, how and why about embryo glue. We also discuss what the studies say about using embryo glue and if it is a treatment option you should use.

Thanks for tuning in to another episode of Taco Bout Fertility Tuesday with Dr. Mark Amols. If you found this episode insightful, please share it with friends and family who might benefit from our discussion. Remember, your feedback is invaluable to us — leave us a review on Apple Podcasts, Spotify, or your preferred listening platform.

Stay connected with us for updates and fertility tips — follow us on Facebook. For more resources and information, visit our website at www.NewDirectionFertility.com

Have a question or a topic you'd like us to cover? We'd love to hear from you! Reach out to us at TBFT@NewDirectionFertility.com

Join us next Tuesday for more discussions on fertility, where we blend medical expertise with a touch of humor to make complex topics accessible and engaging.

Thanks for tuning in to another episode of 'Taco Bout Fertility Tuesday' with Dr. Mark Amols. If you found this episode insightful, please share it with friends and family who might benefit from our discussion. Remember, your feedback is invaluable to us – leave us a review on Apple Podcasts, Spotify, or your preferred listening platform.

Stay connected with us for updates and fertility tips – follow us on Facebook. For more resources and information, visit our website at www.NewDirectionFertility.com.

Have a question or a topic you'd like us to cover? We'd love to hear from you! Reach out to us at TBFT@NewDirectionFertility.com.

Join us next Tuesday for more discussions on fertility, where we blend medical expertise with a touch of humor to make complex topics accessible and engaging. Until then, keep the conversation going and remember: understanding your fertility is a journey we're on together.

Transcript

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Today we talk about em real glue and how it's not actually a glue. But the question is, does it help? I'm, Dr. Mark Amols and this is Taco about Fertility Tuesday. Embryo glue. Is this some amazing substance that's going to change the chances of you getting pregnant with ivf? The simple answer is no, it's not magical. Matter of fact, embryo glue by itself is more impressive by the marketing campaign of coming up with the name than even the substance. But that doesn't mean it's not useful. It is useful and it does have some benefit. And so today we're going to talk about what embryo glue is, how it works, and what are the statistical benefits and studies that back up its use. Embryo, glue is a solution that is gaining popularity in the world of ivf, and that's because of its ability to increase success rates with the IVF procedure. The solution itself is a clear, viscous substance that is made up of what's called hyaluronic. It's a natural substance found in the body. And hyaluron is present in the fluid that surrounds the eggs and the sperm and also in the lining of the uterus. And so this company felt maybe this may benefit by putting it around the embryo when you do, a transfer. Now, first and foremost, it's important to understand this is not a glue. It has no glue like properties. It is, as I stated, a marketing genius idea to call it embryo glue because it basically makes everyone think, it makes it more sticky and thinks things are going to work better. And so, like I said, it is a brilliant marketing campaign. The idea behind embryo glue is to create an environment that is as similar as possible to the natural environment of the womb. And this is important because the embryos need a certain type of environment in order to thrive and grow. And so embryo glue provides somewhat an adhesive surface for the embryo to attach to, which can increase the chances of implantation. But when I say adhesive, I don't mean glue like property, but more the conditions necessary to help with implantation. So essentially what embryo glue is is adding hyaluron to a medium that usually you would transfer embryos in. And the purpose of that is, is to create a substance that is very similar to the environment that would naturally be there. So then how does it work? Well, during the IVF cycle, the embryos are typically transferred into the uterus on the fifth day after fertilization. And at this stage, the embryo is kind of a blastocyst, which is a ball of cells, and these attach into the lining of the uterus in order to grow and to develop. Typically we use a medium that we would normally grow the embryos in, so the normal culture media and use that for transfer. Embryo glue is trying to provide a medium that is more natural, similar to the natural environment, and that may increase the chances of implantation into the uterine lining. What's important to understand is that there are several ways that embryo glue can be used. For example, some clinics will add it to the culture media in which the embryos are already growing before they are transferred to the uterus. Other clinics will actually use it as a coating on the catheter for just the transfer. And other clinics will do both. At our clinic, when we use embryo glue, we do culture the embryo in the embryo glue for at least four hours before the transfer. And then we use the same glue, emerald, to do the transfer. One of the proposed benefits of using Emerald glue is that may increase your success of ivf. And several studies have been conducted on the use of Emerald glue and they have been a little bit mixed, but they're promising studies. It should be no surprise that emerald glue has been a topic of debate. And many IVF specialists believe that the benefits of solution are marginal. And others believe that it can be very useful to help improve success rates. The ones that usually believe it helps usually make it part of their normal protocol, Whereas other clinics who may not believe in it as much usually make it a optional add on for their IVF treatments. One study conducted in 2017 and published in the Journal of Human Reproduction, looked at the use of emeralglue in over 1,300 IVF procedures. The study found that the use of Ameriglue was associated with a significant increase in the clinical pregnancy rate, with a 13% increase in the odds of achieving pregnancy when amberglue was used. The study also found that the use of emeralglue had a positive impact on implantation rates, with a 10% increase in the odds of implantation. Another study conducted in 2019 and published in the Journal of Assisted Reproduction and Genetics, looked at the use of emeralglue in over 1000 IVF procedures. The study found that the use of Emory Glue was associated with a significant increase in the clinical pregnancy rates, with a 14% increase in the odds of achieving pregnancy when embryo glue was used. The study also found that the use of emeralglue had a positive impact on the number of high quality embryos, with a 10% increase in the number of high quality embryos when the embryo glue was used. So it's settled. You should use emery glue, right? The studies showed it worked. Not so fast. Although there has never been a study that has showed embryo glue is harmful, there have been studies that showed there is no statistical benefit to using embryo glue. One Such study in 2018 and published in the Journal of Reproductive Biomedicine Online. That study analyzed the results of over 800 IVF procedures and found no significant difference in the pregnancy rates between patients who received Embryoglu and those who did not. Another study in 2016 and published in the Journal of Reproduction and Infertility also found no significant difference in pregnancy rates or implantation rates between patients who received Emory Glu and those who did not. Okay, so then we shouldn't use embryo glue. Not so fast again. While these studies did not find a significant benefit from using Emerald Glue, they don't necessarily mean that it doesn't work. The IVF procedure results can be influenced by a variety of factors, including the age of the patient, the health of the patient, the quality of the embryos, even the techniques used during the IVF procedure. So now we have studies saying good. We have studies saying there is no benefit. And, there's no studies saying it's not harmful and there really is no harm. Now, that doesn't mean that people can't have a reaction to Hyaluron. It's possible. But in the end, there's no risk to your embryo or lowering pregnancy rates. That has not been found in any study. So I'm sure you're wanting an answer. What should you do? From the scientific standpoint, there really is no true evidence that everyone should use embryo glue. Now let's look at from the standpoint of what if it does work? What if you really do have a 10% increase in implantation? That seems high, right? If your chances are 60% now, it's going to be 70%. But that's actually not how the math works. It's an increase by 10%, which means if your chances are 60%, it will go up 10 to 6%. If your chances are only 40%, then your chances only go up 4%. So using embryo glue in someone who is 42 with untested embryos would essentially only increase your chances by about 1 or 2% versus someone who is younger. Not tested embryos. Again, only a 40, 50% chance of live birth might increase it. Now to for the 5%. The point is, there are things that can increase your chances much higher than Amir glue, such as genetic testing. Doing PGT A can improve your chances significantly at 42, your chance of getting pregnant could be 15 to 20% with a single embryo being transferred. But if you do PGT A now, that embryo may have a 60% chance of live birth because now you've selected the normal embryos. And my goal is not to be a proponent of saying everyone should do testing. But the point I'm saying here is that when you're looking at doing add ons and treatments, it's important to look at how much benefit would it have. I see people all the time not doing PGTA, but then we'll go and do an ERA. Well, an ERA only benefits your chances maybe 10, 15%. Yet the benefit of the PGTA could be much higher. And that's the way I would look at embryo glue. I don't think it's ever harmful. But I also don't believe it works. Well at our clinic we have not seen a benefit from using Emerald glue when used empirically for everyone. However, I do believe that people who have recurrent implantation failure may benefit. Now, that benefit is not going to be amazing and increase your chances by twofold, but will it will do is give you a small increase. And so I'm a big fan of using it when people have implantation failure. But I'm, also not against using it. And anyone who wants to use it, we will. But because we don't believe in it 100%, we don't make it part of our protocol. Anything that we think absolutely works, we make it part of our protocol. That's why we use the Zymod chip, because we believe in it. And that's kind of the problem I have when I see clinics using embryo glue. But they make it an add on. If they truly believe in it and they say it's going to help increase your chances, then why aren't they doing it for everyone? Do they not want the highest chances for everyone? So I feel like you can almost extrapolate from that and say, well, clearly they don't believe in it enough because they're not using on everyone. They're just making an extra upcharge and there's nothing wrong making an add on. We do that as well, but because we don't believe in it. And so only when people have had recurrent implantation failure do I believe it has some benefit. Now the question comes up is why does it cost so much? Well, I can assure you that is due to the company. They charge a lot for it and for that reason it gets passed on to the patient. In the end, what I would tell you is if you only have one embryo, then it's not unreasonable to do it because you're going to give it your best chance. And even a 1%, 2% or even the 5% increase is still an increase. Just like when it comes to the era, we don't recommend it for everyone, but if you only get one shot, it's really not unreasonable. But if you have multiple embryos and you have multiple tries, I don't think it's really worth putting the embryo glue if it costs more. Now, if your clinic does it, it's part of their package, fantastic. But if it's not, it's probably not worth the additional cost when you're doing your first transfer. Now, if you're one of those couples who have had recurrent implantation failure, then there may be some benefit to adding it. When I say recurrent, I mean at least two implantation failures to really be called recurrent implantation failure. That doesn't mean a low hcg. That means no hcg, no implantation. In the end, as we talked about, there is never harm from using imraglu. There may be benefit, there may be no benefit, but there is never harm. And so you're never going to be wrong to use it. You just may not be right because it may not benefit you. But at least you can know you didn't do anything to harm your embryo transfer. I can tell you this is quite a controversial treatment use, and not all REIs use it, and most of us don't agree on it. And so I want you to take my discussion tonight as mostly opinion. Now, obviously the studies I pointed out are true, and that's why I told the, journals they used. But in the end, obviously there was more than those four or five studies, and so I could obviously be picking which ones I think the best or the worst. And so you can do your own studies to look at it. There was a Cochrane review, which takes a bunch of studies and the best of the best studies, and came up with a conclusion that there was a small benefit. And so overall, if you ask me, Dr. Amos, what do you think? Do you think there might be some benefit? The answer would be yes, I do think there probably is some mild benefit. The question is, how large is that benefit? That I don't know. And unfortunately, I don't think anyone's going to know until we have great studies that can look at this. Hopefully this will help you make decisions if you are thinking about using embryo glue or if your doctor is offering it and you don't know if it's worth the cost. Hopefully this helps you make decisions. I look forward to talking to you guys again next week. As always, please feel free to, you know, send topics that you want me to go over. if you like this, tell your friends about it. Send us a, review either through your favorite medium such as Apple Podcasts, Google Podcasts, or Spotify and give us a five star review. I greatly appreciate it. Until next week, this is top Go back for Tiffany Tuesday.