Abstract
Recurrent implantation failure refers to failure to achieve a clinical pregnancy after
transfer of at least four good-quality embryos in a minimum of three fresh or frozen
cycles in a woman under the age of 40 years. The failure to implant may be a consequence of embryo or uterine factors. Thorough
investigations should be carried out to ascertain whether there is any underlying
cause of the condition. Ovarian function should be assessed by measurement of antral
follicle count, FSH and anti-Müllerian hormone. Increased sperm DNA fragmentation
may be a contributory cause. Various uterine pathology including fibroids, endometrial
polyps, congenital anomalies and intrauterine adhesions should be excluded by ultrasonography
and hysteroscopy. Hydrosalpinges are a recognized cause of implantation failure and
should be excluded by hysterosalpingogram; if necessary, laparoscopy should be performed
to confirm or refute the diagnosis. Treatment offered should be evidence based, aimed
at improving embryo quality or endometrial receptivity. Gamete donation or surrogacy
may be necessary if there is no realistic chance of success with further IVF attempts.
Recurrent implantation failure is an important cause of repeated IVF failure. It is
estimated that approximately 10% of women seeking IVF treatment will experience this
particular problem. It is a distressing condition for patients and frustrating for
clinicians and scientists. In this review, we have discussed the definition and management
of the possible underlying causes of recurrent implantation failure.
Keywords
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Article Info
Publication History
Published online: September 16, 2013
Accepted:
August 6,
2013
Received in revised form:
May 5,
2013
Received:
November 13,
2012
Declaration: The authors report no financial or commercial conflicts of interest.Footnotes
Dr Carol Coughlan received her medical training in Ireland and obtained her MRCOG in 2003 and MRCPI in 2004. She completed subspecialist training in reproductive medicine and surgery at the Jessop Wing, Royal Hallamshire Hospital, Sheffield, UK. She is pursuing her research interests in recurrent implantation failure and recurrent miscarriage.
Identification
Copyright
© 2013 Published by Elsevier Inc.
