Embryo Glue, Round Two: Same Glue, New Data

In 2023, we asked a simple question: Should embryo glue be used routinely in IVF?

Since then, more studies have been published, larger analyses have been completed, and the evidence has matured. In this episode, we revisit embryo glue with fresh eyes — separating what hasn’t changed from what actually has.

We discuss why embryo glue is now clearly shown to be non-inferior to standard transfer media, what newer data suggests about small but possible benefits, and why those benefits are often misunderstood. Most importantly, we break down the difference between relative and absolute risk, using real-world examples to explain why a “10% improvement” doesn’t always mean what people think it does.

This episode is about evidence, expectations, and honest counseling — not hype. If you’ve ever wondered whether embryo glue is worth considering, who it may help, and who likely doesn’t need it, this conversation is for you.

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

0:00

Today we talk about round two on embryo glue. Same glue, new data. I'm Dr. Mark Amols and this is Taco about Fertility Tuesday. Well, it's great to be back with my voice. I covered this topic back in 2023. At the time, the conclusion was pretty clear. Embryo glue didn't justify routine use, especially for first time transfers. But since then, more studies have been published, larger analyses have come out, and we now have a better sense of what embryo glue can do and just as importantly, what it can do. Now, I want to be clear up front. This is not a reversal episode. This is an evolutional episode. Medicine M doesn't change just because one study says something new. It changes when patterns start to emerge. And with embryo glue, we now have enough data to say a few things more confidently than we could in 2023. Embryo glue is what we call an IVF add on. There are things that we do that we know, ah, are always beneficial and then there are some things we do that may be beneficial. One of the things we can all agree on is that the name is one of the best names, Embryo glue. But it isn't glue and it really doesn't do anything like glue. And that's the hardest part of not using it because you feel like, why wouldn't I want glue? And then you find out on Facebook, a lot of people used it and they got pregnant. So now you think you need to or someone one time did a transfer that didn't work and then used Emmett glue and it did. So this episode is to help those who are on the fence. But it's important to remember that with any study, if it's not reproducible every time and it's not truly an absolute fact, what I'm saying is that if I take a ball and drop it, it's always going to fall. It doesn't matter how many times you guys do that study, as long as you're on Earth, it's going to fall. Now, if you're in outer space, it may not, but that's a different set of circumstances. And that's one of the issues when it comes to things in medicine. Everybody's body is different, so there's different circumstances. So a lot of times we don't find any study that says the same thing for everyone. Now, it doesn't mean that it doesn't work. It just means that that treatment may not be for everyone. It might be for a select few. So let's start first with what has not changed. Embryo glue does not fix chromosomal abnormalities. It does not make an aneuploid embryo all of a sudden euploid. So it doesn't override embryo biology, and it doesn't turn a poor quality embryo into a great one. If an embryo is never capable of becoming a healthy pregnancy, embryo glue doesn't change that outcome. Think of embryo glue like someone trying to help you paint. You may not be a good painter, but maybe you're pretty good. So with a helper there, you have a better chance of doing a good job. However, if you're like me and have no artistic ability and you're trying to paint, I could have Leonardo da Vinci and Michelangelo sitting right next to me. And I guarantee you that painting will look horrible because I'm bad at painting. And that's the same thing. When it comes to emerald glue, It's a helper. It's not going to all of a sudden make bad embryos work. And that's important to understand. If you've had multiple failed transfers and there's something wrong with the embryos that's causing the transfers not to work, embryo glue is not going to be the difference. So if the place you did IVF at has a 20% pregnancy rate, don't expect Emeralglu, to improve it that much. But there are times when you have recurrent implantation failure that the evidence does show that emerald may help. The question is, is it because of something that's not due to the embryo? So let's talk about what has changed since 2023. Well, we now have stronger evidence in two important areas. One is the safety, and two is that there might be modest benefit for everyone. Let's start with the first one. Non inferiority is now very solid with data. Multiple studies now show that imraglue is non inferior to standard transfer media. So what does that mean? What it's saying is it can't hurt your transfer, so you can feel comfortable using it and know that it may not benefit you, but it absolutely will not hurt your transfer. In a 2025 study in Reproductive biomedicine online, Graco showed that there was no decrease in implantation, pregnancy or live birth rates. There is no increase in miscarriages, and that emerald glue does not worsen outcomes. So in plain English, using emerald glue does not hurt your chances. And this is very important because, like today, I had someone ask if they can do a treatment. I said to them, this treatment is only for people who have recurrent implantation failure. And they said, well, could there be harm? I said, I don't know because no one's done that study yet. Now, we may not think there's harm in certain things, but unless one does, a study improves it. There's always the possibility that something may be inferior. And so what this study has done is at least makes you feel comfortable. There is literally no harm. Again, doesn't mean that there is good, but there is no harm. And I would tell you, be careful just throwing things at a, treatment because you don't know if it could harm it. I'll give you a simple example is I'll see people, put people on blood thinners. I'm not talking baby asthma. I'm saying actual blood thinners when they don't have something like antiphospholipid syndrome. Well, now, something as simple as a little subcortic hemorrhage that they could have walked away from, and now they lose their pregnancy because now they bled too much. There's a situation where something that seems so simple could actually cause more harm. So next, let's talk about the benefit, because this is where the nuance matters. A large systematic review and meta published in Human Reproduction looked at thousands of embryo transfers. Now, in this specific study, they found an odds ratio for live birth of about 1.3. It's about a 30% relative increase, which gives about an absolute increase of around 5 to 7% in certain patients. Now, it's interesting, there was no benefit in donor egg cycles. It was also noted that there were higher twins in this study. So that means we're not really looking at single embryo transfers when they were doing this, because again, this is a systematic review, not a study. And that basically says they looked at multiple studies and then came to a conclusion using all the different studies. That means some studies were poor and some studies showed benefit on average. What I saw was about a relative increase of about 5 to 10% in other studies. So the truth is probably somewhere between about 10 to 30% relative increase. Now, that's a real difference, but it's not dramatic, but it sure sounds like a lot. But let's use 10%. If you use 10% as a relative increase, you would think of your transfer as 60% chance. Now it's 70%. That's not true because it's a relative increase. So 10% of, 60% would only be another 6%. If your chances are only 30%, it would only go up by 3%. I think this is an important part because again, it doesn't mean everyone will get that. As I mentioned, many studies showed no Benefit to people. So just like we talked about before, if I drop a ball, it always falls. That is consistent. But there is no studies showing consistency over and over that there's a benefit. There may be a benefit. Now to a physician or scientist, we may look at that and go, that's not that much, only 3 or 4%. But to a patient that is huge. And that is why IVF add ons sound more impressive than they actually are. Yes, some of them do increase the chances, but it is still very minimal. All of the other things you do, such as embryo quality, matter more. This is why it's so important when you are picking a clinic to do IVF at, to make sure to find out what their statistical chances are that will provide the best chances for you. Now, in 2023 we did talk about how there is some benefit shown for people who have prior failed transfers or even recurrent implantation failures. And again, this was seen as well in two studies in 2023 they showed that when it comes to recurrent implantation failure that there was a higher clinical pregnancy rate compared to without using it. What was interesting in one of the studies is they didn't find a higher live birth rate. Statistically it was higher, but not statistically. So basically saying imerglow helped to implant, but it didn't guarantee that the pregnancies would continue. Basically these studies said there may be a benefit, but it's not prentice enough to oversell using the embryo glue. And this is the point still, if anything, the thing you should walk away from is it does not hurt your chances. But the gains, although small, may still matter. Understand that embryo glue does not make up, for poor embryo quality. That should always be your goal first. So the question is, who does need it and who does not? Well, basically, if you're doing your first transfer with a high quality euploid embryo, the evidence does not strongly support routine use of emerald. If you're someone who's had failed transfers, especially recurrent implantation failure, then there may be some benefit and there's more supportive data to show to use in that situation now, it's still not a huge benefit. As we talked about, it might have a relative increase, but that is just purely relative and is still small. In one REI community group where we were discussing amiroglu, I wasn't shocked to see that pretty much every single reproductive doctor in that group when asked about amyglur were kind of like, meh, it's okay. And that's not a great signal when even the fertility Doctors are like, you can use it. If you can't sell the people who are in this profession, then it tells you it's really not that great. But it does have a great name. No one's going to argue with that. Now. That doesn't mean that you shouldn't use it. What I'm just saying is I don't want you to put a lot of hope into it and understand that the benefit could maybe be 1%, maybe as high as 6%. But when your transfer doesn't work, you shouldn't think first. Okay, I need emerald glue. What you should think is, is there something else wrong? Was the embryo good quality? Does this clinic have good rates? Those are more important than just adding embryo glue. So where does this leave us? Well, it tells us that embryo glue is safe. It's clearly non inferior. The benefit, if present, is small and very dependent on the context. That doesn't mean it's useless. It means it needs to be explained. Honestly. In the end, infertility small gains matter, but only if patients understand what those gains really are. I, know choosing to use emir glue is always a tough decision and usually is a financial one as well. You can now say there's no reason to not do it. Just understand the benefit may not be there for you, but it may be for someone else. Unfortunately, there is no nomogram that can determine which patients it's good for and which ones it's not. But what there is proof of is it won't hurt anyone's chances. Hopefully you found this episode helpful. Maybe you're on that edge where you're trying to decide, do I want to use it or not use it and were wondering, is there any harm in using it? And now you know, maybe one of your friends are thinking about going through IVF and had the same question. Now you're educated and you can teach them. As always, I greatly appreciate everyone that listens to this podcast. I greatly appreciate everyone who sends in ideas for podcasts@tbftewdirectionfertility.com if you like this podcast, please tell your friends about it. Give us a five star review on your favorite medium, but most of all, keep coming back. I look forward to talking to you again next week on Taco Bell Fertility Tuesday.