What to do when good-quality embryos repeatedly fail to implant

Area of Science:

• Reproductive Medicine
• Infertility Research
• Clinical Gynecology

Background:

• Recurrent implantation failure (RIF) presents a significant challenge in assisted reproductive technology, impacting numerous couples and clinicians.
• RIF is clinically defined as the failure to achieve pregnancy after transferring at least four good-quality embryos across three or more IVF cycles in women under 40.
• A standardized diagnostic and management protocol for RIF is essential for effective patient care.

Purpose of the Study:

• To outline a comprehensive approach for investigating and managing recurrent implantation failure.
• To identify key diagnostic steps and therapeutic strategies for couples experiencing RIF.
• To provide clinicians with an evidence-based framework for addressing RIF.

Main Methods:

• Assessment of ovarian reserve through antral follicle count, FSH, and AMH.
• Exclusion of genetic abnormalities via couple's chromosomal testing.
• Diagnostic imaging and procedures including ultrasonography, hysteroscopy, and hysterosalpingogram to rule out uterine pathologies and hydrosalpinges.
• Consideration of preimplantation genetic screening (PGS) and freeze-all protocols.

Main Results:

• Identification of specific diagnostic criteria and investigations for RIF.
• Highlighting the importance of excluding ovarian, genetic, uterine, and tubal factors.
• Emphasizing evidence-based treatments focused on enhancing embryo quality and endometrial receptivity.

Conclusions:

• A systematic investigation protocol is vital for diagnosing the causes of RIF.
• Management should involve targeted treatments to improve IVF outcomes.
• Alternative options like gamete donation or surrogacy may be considered when RIF persists.