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Reprod Biomed Online. 2014 Jan;28(1):14-38. doi: 10.1016/j.rbmo.2013.08.011. Epub 2013 Sep 14.

Recurrent implantation failure: definition and management.

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Department of Reproductive and Developmental Medicine, Jessop Wing, Royal Hallamshire Hospital, Sheffield, United Kingdom.
Department of Obstetrics and Gynaecology, Royal Hospital for Women, Sydney, Australia.
Reproductive Centre, First Affiliated Hospital of Sun Yat Sen University, Guangzhou, China.
The Women and Children Hospital of Guangdong Province, No. 13, Guangyuan Road West, Guangzhou 510010, China.
Women's Health, Infertility and IVF Centre, Cankaya Caddesi, 20/3, Ankara, Turkey.
Monash IVF, Gold Coast, Australia.
Department of Obstetrics and Gynaecology, University of Alexandria and Suzanne Mubarak Regional Centre for Womens Health and Development, Alexandria, Egypt.
Department of Reproductive and Developmental Medicine, Jessop Wing, Royal Hallamshire Hospital, Sheffield, United Kingdom. Electronic address:


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-Mu¨llerian 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.


IVF; embryo; failure; fibroids; hysterosalpingogram; implantation

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