Abstract
Recurrent implantation failure (RIF) is generally defined as the failure to achieve clinical pregnancy after the transfer of at least 6 good quality embryos in fresh or frozen IVF cycles or of at least 4 embryos in two egg donations. Patients with RIF represents an heterogeneous group in which diverse immunological or inflammatory factors have been described, representing globally the more frequent known causes, including antiphospholipid syndrome or autoimmune thyroid disease, among others. However, there is a lack of evidence-based reviews focusing on inflammatory RIF (iRIF). We performed a systematic review of the published literature on iRIF from 1988 to July 2016, in order to build an updated evidence-based classification of immunological diagnostic tests and assigned recommendations accordingly. This review intends to offer a useful immunological workout of women suffering RIF from a multidisciplinary approach.
Highlights
To date there is a lack of a clear-cut consensus on the definition of recurrent implantation failure (RIF), which impacts on the absence of reliable data about its incidence and prevalence [1]
RIF is generally defined as the failure to achieve clinical pregnancy after the transfer of two good quality embryos, in at least three fresh or frozen in-vitro fertilization (IVF) cycles/embryo transfers (6 embryos in total) or in at least two egg donations (EG, i.e. 4 embryos in total) [3]
This review intends to provide an updated picture of the causes and factors contributing to inflammatory RIF (iRIF) and to classify them according to the current evidence for the diagnosis of couples with RIF
Summary
To date there is a lack of a clear-cut consensus on the definition of recurrent implantation failure (RIF), which impacts on the absence of reliable data about its incidence and prevalence [1]. Three generic definitions can be considered according to: the number of unsuccessful assisted reproduction treatment cycles; the number of embryos transferred; or a combination of both factors [2]. RIF is generally defined as the failure to achieve clinical pregnancy after the transfer of two good quality embryos, in at least three fresh or frozen IVF cycles/embryo transfers (6 embryos in total) or in at least two egg donations (EG, i.e. 4 embryos in total) [3]. Some studies define RIF as the failure to achieve pregnancy following repeated IVF cycles Considering that embryo quality is closely related to maternal age, some definitions will only consider failed IVF transfer cycle in women younger than 40 years [5]. Studies on pre-implantation genetic diagnosis (PGD) refer up to 67% of aneuploidy embryos in patients with RIF [8]
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