Abstract
Recurrent implantation failure (RIF) is an uncommon, imprecisely defined clinical disorder characterized by failure to achieve pregnancy after repeated embryo transfers. The diverse etiologies and incomplete understanding of RIF provide significant diagnostic and therapeutic challenges to patients and providers. Careful clinical evaluation prior to assisted reproduction can uncover many treatable causes, including thyroid dysfunction, submucosal myomas, and tobacco use. The more-subtle causes often require a more-targeted assessment. Undetected, small polyps or small areas of intrauterine synechiae are relatively common and easily treated contributors to RIF. Molecular and cellular abnormalities pose a greater therapeutic challenge. Putative causes of RIF, including progesterone resistance, shifted window of receptivity, decreased integrin expression, and immunologic disturbances, should be considered in the evaluation of a patient with otherwise unexplained RIF. It may also be true that a more complex and standardized definition of RIF would be helpful in these cases. In this paper, we review the diagnostic and therapeutic approaches to RIF, with emphasis on disorders of endometrial receptivity.
Highlights
Embryo implantation is a delicately coordinated event, relying on multicomponent, bidirectional signaling between the embryo and endometrium[1,2]
There is no universally agreed upon definition, recurrent implantation failure (RIF) is often defined as the failure to achieve clinical pregnancy after the transfer of four or more good-quality embryos
Alonso et al.[41] utilized this analysis to show that approximately 25% of patients with RIF had an altered window of implantation (WOI), with the correct gene signature occurring before or after the expected time of 5.5 days of progesterone exposure. These results argued for personalized embryo transfer timing
Summary
F1000 Faculty Reviews are written by members of the prestigious F1000 Faculty. They are commissioned and are peer reviewed before publication to ensure that the final, published version is comprehensive and accessible. The reviewers who approved the final version are listed with their names and affiliations. Any comments on the article can be found at the end of the article
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