Dr Wan Teh - Gynaecologist & Fertility Specialist (melbourne IVF)

Dr Teh has ongoing research involvement. Under the National Health and Medical Research Council (NHMRC) scholarship, she is investigating the determinants of uterine receptivity in women with implantation failure. What this means for women looking to conceive, Dr Teh aims to optimize the rates of success for pregnancy establishment.

Uterine Receptivity

Pregnancy occurs when an embryo (fertilized egg) attaches to the endometrium (lining of the womb). Successful establishment of pregnancy requires a healthy embryo, a uterus which is in a state that can accept the embryo (uterine receptivity), and a synchronized development of the embryo and the endometrium. This happens at a particular time of the woman’s menstrual cycle. If the growth and development of an embryo is not matched with the stage of the woman’s cycle (embryo-endometrial asynchrony), such that the endometrium can accept the embryo, then implantation or pregnancy may not occur. The following diagram demonstrates the role of embryo-endometrial synchrony in successful implantation.

Where indicated for patients, Dr Teh utilizes the Endometrial Receptivity Array (ERA) test, and/or performs Endometrial Stimulation (“scratch”) procedure to improve uterine receptivity and pregnancy conception rate.

Endometrial Receptivity Array (ERA)

Endometrial Receptivity Array (ERA) is a personalized genetic test to diagnose the state of endometrial receptivity in women. This test is recommended for women who have had recurrent implantation failure with good embryos, who may be suffering from embryo-endometrial asynchrony.

Endometrial stimulation (‘scratch’)

Endometrial ‘scratch’, also known as endometrial injury or biopsy is a procedure to induce mechanical injury to the endometrium by pipelle endometrial biopsy or hysteroscopy and curette. Previously, low quality evidence has suggested that endometrial injury may improve IVF success, especially in women with previous implantation failure (Vitagliano et al., 2018).

Clear evidence has been provided by a randomized, controlled study that was published at the New England Journal of Medicine recently. This multicentre trial involving a total of 1364 women has shown that endometrial scratching does not improve live birth rate in women undergoing IVF when compared to no endometrial intervention. (Lensen et al., 2019)

As there is clear evidence now that endometrial scratching does not improve pregnancy rate in standard IVF, it is no longer recommended. However, in women with recurrent implantation failure, you may still be recommended to have an outpatient pipelle biopsy or hysteroscopy with endometrial biopsy to investigate for endometrial causes of implantation failure, such as endometritis, polyps, adhesions etc.

Latest research paper


Scientific papers:

1. A Randomized Trial of Endometrial Scratching before In Vitro Fertilization. Lensen S, Osavlyuk D, Armstrong S, Stadelmann C, Hennes A, Napier E, Wilkinson J, Sadler L, Gupta D, Strandell A, Bergh C, Vigneswaran K, Teh WT, Hamoda H, Webber L, Wakeman SA, Searle L, Bhide P, McDowell S, Peeraer K, Khalaf Y, Farquhar C. N Engl J Med. 2019 Jan 24;380(4):325-334.
2. Genetic regulation of disease risk and endometrial gene expression highlights potential target genes for endometriosis and polycystic ovarian syndrome. Fung JN, Mortlock S, Girling JE, Holdsworth-Carson S, Teh WT, Zhu Z et al. Sci Rep. 2018 Jul 30;8(1):11424.
3. What is the contribution of embryo-endometrial asynchrony to implantation failure? Teh WT, McBain J, Rogers P. J Assisted Reproduction and Genetics. 2016 Nov; 33(11): 1419-1430.
4. Endometrial vezatin and its association with endometriosis risk. Holdsworth-Carson SJ, Fung JN, Luong HT, Sapkota Y, Bowdler LM, Wallace L, Teh WT, Powell JE, Girling JE, Healey M, Montgomery GW, Rogers PA. Human Reproduction. 2016 May;31(5):999-1013.
5. The impact of uterine radiation on subsequent fertility and pregnancy outcomes. Teh WT, Stern C, Chander S, Hickey M. Biomed Research International. 2014;2014:482968.
6. Quantifying circulating hypoxia-induced RNA transcripts in maternal blood to determine in utero fetal hypoxic status. Whitehead C, Teh WT, Walker SP, Leung C, Mendis S, Larmour L, Tong S. BMC Med. 2013 Dec 9;11:256.
7. Circulating MicroRNAs in maternal blood as potential biomarkers for fetal hypoxia in-utero. Whitehead CL, Teh WT, Walker SP, Leung C, Larmour L, Tong S. PLoS One. 2013 Nov 25;8(11):e78487.
8. Gestational diabetes: development of an early risk prediction tool to facilitate opportunities for preven tion. Teede HJ, Harrison CL, Teh WT, Paul E, Allan CA. Australian and New Zealand Journal of Obstetrics & Gynaecology. 2011 Dec;51(6):499-504.
9. Risk factors for gestational diabetes mellitus: implications for the application of screening guidelines. Teh WT, Teede HJ, Paul E, Harrison CL, Wallace EM, Allan C. Australian and New Zealand Journal of Obstetrics & Gynaecology. 2011 Feb;51(1):26-30.
10. Umbilical endometriosis, a pathology that a gynecologist may encounter when inserting the Veres needle. Teh WT, Vollenhoven B, Harris PI. Fertility & Sterility. 2006 Dec;86(6):1764.e1-2.