It’s hard enough when a good embryo doesn’t implant, and harder still when it happens again. Doctors call this pattern recurrent implantation failure, or RIF, and they usually use that name once three or more good quality or genetically normal embryos have been transferred without a pregnancy.
According to Dr. Mohit Saraogi, IVF Doctor in Mumbai, “Repeated failed transfers are exhausting for couples, and the first question is always why. In most cases a careful investigation turns up something we can act on, such as a problem in the womb or in the embryos. That is why we go step by step rather than simply trying again.”
Curious how doctors work out why transfers keep failing?
What Causes Recurrent Implantation Failure?
Ask any fertility specialist what causes RIF and you’ll usually hear the same answer: it depends. More often than not it’s a combination of factors, and in some couples nothing shows up at all.
Embryo factors: The embryo itself is the most common suspect. A good looking one can still carry a chromosome error, and the odds of that go up with the mother’s age.
Uterine factors: Then there’s the womb. A polyp or a fibroid can get in the way, and so can scar tissue, a septum or an infection of the lining that has been there for a while.
Medical conditions: General health counts as well. Thyroid trouble, diabetes that isn’t well controlled and fluid in a blocked fallopian tube can all lower the chance of implantation.
Sperm and lifestyle: Sperm are part of the story too, especially when their DNA is damaged. Smoking and a very high or very low body weight can add to the problem in some couples.
Womb problems are often the easiest to find and fix, and a quick look inside with hysteroscopy is usually how we do it.
Which Tests Help Find the Cause of Recurrent Implantation Failure?
We usually begin with the simple checks and bring in the specialised ones only if they’re needed. So no two couples end up with exactly the same set of tests.
A review of past cycles: We start by going back through your earlier cycles. How did you respond to the medicines, how did the embryos grade and how was each transfer done? And sometimes a detail that was missed the first time jumps out on a second look.
Scans and hysteroscopy: A scan of the womb and tubes comes next. Hysteroscopy is a step beyond that, since the doctor can see inside the womb and fix small problems in the same sitting.
Blood and lab tests: Thyroid, sugar and vitamin levels are checked with a simple blood test. And if an infection of the womb lining is suspected, a small sample can be tested for that too.
Embryo and sperm tests: Sperm DNA testing and genetic testing of embryos are added when needed. They help us see whether the trouble is with the embryos or the womb, and that changes what we do next.
When the cause still isn’t clear, timing of the transfer is sometimes the missing piece. Our blog on the ERA test explains how that is checked.
What Can Be Done Once the Cause Is Known?
What we do next depends on what the tests show. Sometimes the answer is plain, but sometimes we get there by ruling things out.
Treat what is found: Anything that turns up gets treated first. A polyp can be taken out, an infection cleared and a thyroid problem corrected. And each of these can give the next transfer a better chance.
Test the embryos: We can also test the embryos before transfer and pick the ones with the right chromosome count. That matters most for women over 35, so it comes up often in that group.
Adjust the transfer: The transfer itself can be changed too. That might mean a different embryo stage, different medicines to prepare the lining or a different day.
Look after the emotional side: Several failed cycles are hard on a couple, and that part of the process is easy to overlook. Counselling, or just a break between cycles, can help more than most people expect.
Once the cause has been dealt with, many couples go ahead with a planned frozen embryo transfer.
Key Takeaways : RIF means good embryos keep failing to implant over repeated transfers, and it seldom comes down to one cause. The work up goes through the embryos, the womb and your general health one step at a time. More often than not a cause turns up, and treating it gives the next transfer a better chance.
Wondering which tests might make sense after repeated failed transfers?
Frequently Asked Questions
What is recurrent implantation failure?
It means repeated IVF transfers of good quality embryos that don’t lead to a pregnancy, usually three or more. The exact definition varies slightly between clinics.
How many failed transfers count as RIF?
Most clinics use three or more failed transfers of good quality embryos. Some begin the work up earlier if you are over 35.
Is RIF treatable?
In many cases, yes. Once the cause is known, it can often be dealt with by fixing a womb problem or choosing genetically tested embryos, though outcomes can never be promised.
What tests are done for RIF?
It usually starts with scans and a hysteroscopy. Blood, sperm and embryo tests are added only where they’re needed, so no two couples have exactly the same list.
References:
- PMC (NIH/NLM) — Recurrent implantation failure: A comprehensive summary from etiology to treatment: https://pmc.ncbi.nlm.nih.gov/articles/PMC9849692/
- PMC (NIH/NLM) — Diagnostic and therapeutic options in recurrent implantation failure: https://pmc.ncbi.nlm.nih.gov/articles/PMC7101014/
Disclaimer:
This blog is intended for informational purposes only and should not be considered a substitute for professional medical advice, diagnosis, or treatment.