Recurrent Implantation Failure

What is recurrent implantation failure?

Recurrent implantation failure (RIF) describes repeated failure to achieve a pregnancy after transferring good-quality embryos during IVF. There is no single agreed definition. It is commonly used when a woman under 40 has not conceived after transfer of several good-quality embryos, often three or more, over multiple transfers. ESHRE describes RIF as failing to conceive when the expected cumulative chance of implantation was high. The diagnosis is a reason to review the whole treatment, not a verdict that pregnancy is impossible.

Symptoms and signs

RIF has no physical symptoms. It is recognised by negative pregnancy tests or very early biochemical pregnancies after repeated embryo transfers.

Causes and risk factors

• Embryo factors: chromosomal abnormalities (aneuploidy) are the most common reason embryos fail to implant, and become more frequent with the woman's age
• Uterine factors: polyps, submucosal fibroids, adhesions, a septum, adenomyosis or chronic endometritis
• Hydrosalpinx: fluid from a blocked tube can reduce implantation
• Thin endometrium
• Sperm factors: such as high sperm DNA fragmentation
• Medical conditions: antiphospholipid syndrome, untreated thyroid disease or poorly controlled diabetes
• Lifestyle: smoking and obesity
• Chance: even good-quality embryos do not always implant, so some couples have had repeated bad luck

How it is diagnosed

• Review of previous cycles: stimulation, egg and embryo numbers, embryo grading and transfer technique
• 3D ultrasound and hysteroscopy to examine the uterine cavity
• Ultrasound or HSG to check for hydrosalpinx
• Endometrial biopsy for chronic endometritis where suspected
• Thyroid tests, blood sugar and antiphospholipid antibodies
• Karyotype of both partners in selected cases
• Semen analysis and, where appropriate, sperm DNA fragmentation testing

Tests such as endometrial receptivity analysis and immune or natural killer cell testing are offered at some clinics, but current evidence does not show clear benefit, and they are not recommended routinely by ESHRE.

Treatment options

• Hysteroscopic correction of polyps, fibroids, adhesions or septum
• Removal or clipping of a hydrosalpinx before the next transfer
• Antibiotics for confirmed chronic endometritis
• Treatment of thyroid disease, diabetes or antiphospholipid syndrome
• Optimising the endometrium, often with a frozen embryo transfer in a prepared cycle
• Preimplantation genetic testing for aneuploidy (PGT-A) in selected patients, to help choose embryos with the normal number of chromosomes
• Lifestyle changes, including stopping smoking and reaching a healthy weight
• Donor eggs when egg quality is the main issue, or gestational surrogacy in rare cases where the uterus cannot support a pregnancy

Chances of pregnancy

Many women with RIF conceive in later cycles, especially when a correctable cause is found or when chromosomally normal embryos are available. The chance depends mostly on the woman's age at egg collection and embryo quality. Your specialist can explain your realistic options, but no treatment can guarantee success.

When to see a fertility specialist

Seek a detailed review if you have had two or more failed transfers of good-quality embryos, or after a single failure if you are over 38. A fresh evaluation can identify changes worth making before your next cycle. Iswarya Fertility has 91+ centres, with EMI options from ₹9,999 per month for eligible treatments.