Using MAGENTA™ to Clarify Oocyte vs. Uterine Factors in an IVF-ICSI patient with Endometriosis
Endometriosis has been consistently shown to decrease IVF success rates. Several mechanisms have been proposed to explain its negative impact, including reductions in egg quality and quantity, a hostile inflammatory environment in the fallopian tubes and surrounding tissue, immune dysfunction, and a less receptive uterine lining.
When outcomes fall short, the key clinical question facing patients and clinicians becomes: is the underlying issue mainly the “seed” (a non-viable embryo resulting from a low-quality egg) or the “soil” (a combination of factors preventing successful implantation of a viable embryo)? Distinguishing between the two is rarely straightforward — yet it is critical for guiding the next step in care.
MAGENTA™ provides objective insights into oocyte quality, helping clinicians clarify that distinction and make more targeted, confident decisions for what comes next.
- 35-year-old female G0P0 with Stage II endometriosis (history of chronic pelvic pain and laparoscopic confirmation of endometriosis)
- 3 years of primary infertility
- Ovarian reserve within expected range for age; normal male work-up
- Failed 3 cycles of IUI with ovarian stimulation
- IVF-ICSI planned
- 16 oocytes retrieved; 13 mature
- ICSI performed → 11 oocytes fertilized
- 6 blastocysts developed and were cryopreserved without PGT-A biopsy testing.
- All frozen embryos were graded as high quality using Gardner criteria and morphokinetic parameters assessed by time-lapse imaging.
- 4 FET cycles (two medicated, two modified natural cycle) were unsuccessful despite achieving adequate endometrial thickness.
- 2 embryos remain frozen.
- The patient has arranged a follow-up appointment to discuss next steps in her care.
- The majority of oocytes are in the medium-high and high-quality ranges, with a smaller subset of low-medium scores.
- Interpretation: MAGENTA™ scores were consistent with age-related expectations and do not indicate a need for PGT-A testing of the remaining embryos.
In this endometriosis case, MAGENTA™ provided objective evidence supporting oocyte competence as unlikely to be the primary limiting factor — a finding consistent with the development of six high-quality embryos. Given the numerous unsuccessful FET cycles despite good embryo quality in a 35-year-old patient, the clinical focus now shifts more confidently toward endometrial receptivity as the likely contributor to failed implantation.
- Counselling: MAGENTA™ provided objective data supporting that egg quality was not the rate-limiting step, allowing the team to refocus the conversation on what was more likely contributing to her multiple failed FET cycles.
- Treatment planning: The focus shifted to the “soil” — prioritizing endometriosis-targeted FET preparation, including three months of hormonal suppression and additional progesterone support.
- Reducing trial-and-error: By helping to identify the most likely contributor to failed implantation, MAGENTA™ enabled more targeted decision-making — reducing the need for broad, empirical protocol changes and giving the patient a clearer path forward.
If you’ve found this example helpful in understanding how MAGENTA™ can be incorporated at your clinic or have feedback on other aspects related to your use of Future Fertility’s egg quality assessments, please share it with us at info@futurefertility.com.
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