Recurrent Implantation Failure

Published in August 2020
Compiled by Team ISAR 2020-2021

Repeated implantation failure (RIF) is a condition in which the woman is not able to get clinically pregnant after 2 or 3 attempts of embryo transfer. Multiple failed cycles can leave couples frustrated and desperate for answers.

The Management of RIF Embryonic / gamete factors:

Egg and sperm quality & quantity

For ovarian reserve, anti-Mullerian hormone (AMH) and antral follicle counts AFC, Basal FSH can be done. PCOD & endometriosis can be managed before starting the process A good controlled ovarian stimulation protocol helps. Karyotyping of the couple to identify any genetic abnormality. A healthy lifestyle and use of antioxidants to enhance quality of the gametes. If maternal age is above 40 years then donor egg could be a preferred option. DNA fragmentation index can be done to identify sperm damage. High magnification IMSI or surgical sperm retrieval (TESA) can be done to select the best quality sperm for ICSI. Donor sperm can be used in cases of azoospermia.


Preimplantation genetic tests such as PGT/PGD can be done before implantation to select good quality normal embryos, This is the testing of the genetic composition of embryos. It helps to identify chromosomally normal embryos

Assisted hatching - which helps release the embryos from its thick covering –zona

Blastocyst culture and transfer to increase the chances of implantation

Better embryo selection with Time lapse imaging (embryoscope), metabolomics

Endometrial factors


This is a minimally invasive surgical technique used in viewing and assessing the inside of the uterus (uterine cavity) to diagnose or treat fertility. It allows for removal of polyps,submucousfibroid,adhsions and correct other uterine cavity abnormalities and has shown to increase the chances of women becoming pregnant.


This is also a minimally invasive surgical procedure used to examine the organs inside the abdomen, such as ovaries, uterus and fallopian tubes. Laparoscopy may be needed to block the fallopian tubes or remove them (salpingectomy) in case of gross hydrosalpinges, and to also clear endometriosis and cysts if any.

Endometrial Receptivity Assay (ERA):

This is the most recent test of endometrial receptivity, whichanalyzes the expression levels of the 236 genes to assess the optimal time to place an embryo into the uterus to promote a successful implantation and pregnancy . It is reproducible and very accurate at determining when the window of implantation is open so it tells us if the endometrium is receptive or not. Some women might have a receptive uterus at an earlier time than expected and some might be receptive at a later time. Infertility specialists can then use this information to change the time that embryos are placed into the uterus so that it matches up better with the window of implantation.

Medications and Therapies

have been tried for certain conditions. While some of these have proven therapeutic value, others still lack definite clinical evidence.
Thrombophilia - Heparin, Aspirin, Steroids
Immunological causes - IVIG, Intralipid, Immunotherapy
Others - GCSF, PRP (Platelet rich plasma), PBMC (peripheral blood mononuclear cells-stem cells)

Donor eggs and Surrogacy:

A woman who is too old or has premature ageing of her ovaries might not have a successful in vitro fertilization (IVF) cycle. Such patients may opt to use donor eggs. If the uterine problem cannot be resolved then surrogacy is the option.
The trauma of repeated failures , combined with the lack of a clear explanation about the cause of the failures leads to continued stress in patients. Please don’t lose hope as RIF can be diagnosed and can be managed increasing the chances of conceiving by IVF.

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