Repeated Implantation Failure (RIF) in IVF Cycles

Repeated implantation failure (RIF) remains one of the unsolved issues in IVF treatments, and although the extensive research in order to find and understand the causes for this condition our knowledge remains limited. Even the criteria for the diagnosis of RIF are still vague but it is acceptable that failure to conceive after three consecutive IVF treatments, in which one to two embryos of high quality are transferred in each cycle, can be identified as RIF. The causes for repeated implantation failure can be attributed to each of the key role players, the mother, the endometrium, the embryo, the interplay between them, or all together. The Maternal factors can be thrombophilia, obesity, cigarette smoking, thyroid dysfunction, immune factors, and various metabolic diseases. The Endometrium factors that can reduce the receptivity are varied, for example, uterine anatomic abnormalities such as polyps, Septated Uterus, Fibroids, Asherman Syndrome and thin Endometrium. We also know that in the last years the evolving molecular research contributed new evidence regarding abnormal endometrial gene and proteins expression, probably influencing the adhesive molecule and finally, endometriosis and hydrosalpinx can be related to reduce endometrial receptivity. The Embryonic reasons can be associated with genetic abnormalities arising from the ovum or the sperm, or both. Suboptimal Embryo culture and transfer technique and probably other factors may contribute to this unsolved "black box" phenomena. In our lecture we will review the approach to the different etiologies and the state of the art in treating them.