You've done everything right — high-quality embryos, perfect timing, expert clinic. But the pregnancy test is still negative. This is Recurrent Implantation Failure (RIF), and it's one of fertility medicine's most complex puzzles. But every mystery has a solution.
Understanding
Embryo Factors
Uterine Factors
Immune Factors
Treatment Plan
Success
Recurrent Implantation Failure is defined as failure to achieve a clinical pregnancy after transfer of at least 4 high-quality embryos in a minimum of 3 fresh or frozen cycles in women under 40 years of age.
Some experts define RIF as 2 failed transfers with euploid (PGT-A tested) embryos, recognizing that embryo quality is the most critical factor.
Click each card to reveal the findings.
Blood clotting disorders can cause micro-thrombi in placental vessels.
An autoimmune profile that can affect placental blood vessels.
Elevated uterine natural killer (NK) cells are theorized to impair implantation in some cases.
Uncontrolled thyroid disease and hyperprolactinemia can impair implantation.
A systematic, evidence-based investigation covering every major contributor to implantation failure.
✔PGT-A (preimplantation genetic testing for aneuploidy)
✔Sperm DNA fragmentation testing
✔Review of embryo grading and development timeline
✔Consider time-lapse monitoring for future cycles
✔3D transvaginal ultrasound
✔Saline sonohysterography (SHG)
✔Hysteroscopy (gold standard)
✔Hysterosalpingogram (HSG) if not recently done
✔ERA (Endometrial Receptivity Analysis)
✔Endometrial biopsy for chronic endometritis (CD138 staining)
✔Assessment of endometrial thickness and pattern
✔Antiphospholipid antibody panel
✔Inherited thrombophilia panel
✔Thyroid function (TSH, free T4, thyroid antibodies)
✔Prolactin level
✔HbA1c for glucose control
✔Parental karyotyping (balanced translocations)
✔Vitamin D level
✔BMI optimization
✔Lifestyle factors (smoking, alcohol, stress)
Level A — Strong Evidence
Transfer only chromosomally normal (euploid) embryos.
✔Reduces miscarriage rate by 50–60%
✔Improves live birth rate per transfer
✔Reduces time to pregnancy
✔Particularly beneficial for women over 35 or with RIF
Level B — Moderate Evidence (RIF Only)
Personalized embryo transfer timing based on endometrial gene expression.
Level A — Strong Evidence
Removal of polyps, fibroids, adhesions, or septum.
Level B — Moderate Evidence
Antibiotic treatment (doxycycline 100mg twice daily for 14 days).
Level C — Limited Evidence
IVIG, intralipids, or steroids for elevated NK cells or immune dysfunction.
Level A — Strong Evidence (For APS/Thrombophilia)
Low-dose aspirin + LMWH for antiphospholipid syndrome or inherited thrombophilias.
Of RIF patients achieve pregnancy after comprehensive workup and targeted treatment (range 40–60%)
Pregnancy rate with euploid embryo transfer in RIF patients (range 50–60%)
Clinical pregnancy rate with ERA-guided transfer in RIF patients with displaced window of implantation (vs 32% standard, in studies reporting this effect)
Improved pregnancy rates after hysteroscopic removal of polyps/fibroids in RIF
All-in-one diagnostic protocol.
Identify euploid embryos.
Personalized transfer timing.
Correct anatomical issues.
Evidence-based immune protocols.
40–60% pregnancy rate in RIF.