Abstract
Recurrent implantation failure (RIF) is an undefined, quite often, clinical phenomenon that can result from the repeated failure of embryo transfers to obtain a viable pregnancy. Careful clinical evaluation prior to assisted reproduction can uncover various treatable causes, including endocrine dysfunction, fibroid(s), polyp(s), adhesions, uterine malformations. Despite the fact that it is often encountered and has a critical role in Assisted Reproductive Technique (ART) and human reproduction, RIF’s do not yet have an agreed-on definition, and its etiologic factors have not been entirely determined. ART is a complex treatment with a variable percentage of success among patients and care providers. ART depends on several factors that are not always known and probably not always the same. When confronted with repeated ART failure, medical care providers should try to determine whether the cause is an embryo or endometrium related. One of the most common causes of pregnancy failure is aneuploidy. Therefore, it is likely that this represents a common cause of RIF. Other RIF potential causes include immune and endometrial factors; however, with a very poorly defined role. Recent data indicate that the possible endometrial causes of RIF are very rare, thereby throwing into doubt all endometrial receptivity assays. All recent reports indicate that the true origin of RIF is probably due to the “egg”.
Highlights
Assisted Reproductive Technique (ART) is a complex treatment with a variable percentage of success among patients and care providers
Our results suggest that the vast majority of repeated implantation failure (RIF) are of embryonic origin, which can be considerably reduced by transferring embryos tested by PGT-A
Based on etiology, RIF seems to be more of an iatrogenic invention than a real diagnosis [58], and it produces an opportunity for a lot of unwarranted medical activity
Summary
Assisted Reproductive Technique (ART) is a complex treatment with a variable percentage of success among patients and care providers. When confronted with repeated ART failure, medical care providers should try to determine whether the cause is embryo or endometrium related, and they must determine how many ART failures define true repeated implantation failure (RIF) [1]. Despite the increased research and debates regarding RIF, it remains an enigmatic phenomenon with no agreed-on definition. Despite the increased research regarding this topic, no medical society agreed on a definition and/or minimal measures to follow in the case of RIF. The early hypothesis proposed that RIF was defined as ART failure after at least 10 embryos were transferred. While the majority propose alternate cut-offs, when considering euploidy status and/or maternal age, the definition might be adjusted to two or more failed embryo transfers [5]. Today we can affirm the majority of ART specialists would declare the existence of RIF after at least four failed embryo transfers of good morphology/quality embryos [3]
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