Revisiting the management of recurrent implantation failure through freeze-all policy

A freeze-all policy may improve clinical pregnancy, implantation, and ongoing pregnancy rates in cases with recurrent implantation failure.

Volume 108, Issue 1, Pages 72–77


Yasmin Magdi, M.Sc., Ahmed El-Damen, M.Sc., Ahmed Mohamed Fathi, M.Sc., Ahmed Mostafa Abdelaziz, M.D., Mohamed Abd-Elfatah Youssef, M.D., Ph.D., Ahmed Abd-Elmaged Abd-Allah, M.D., Mona Ahmed Elawady, M.D., Mohamed Ahmed Ibrahim, M.D., Yehia Edris, M.D.



To determine whether a freeze-all policy for in vitro human blastocysts improves the ongoing pregnancy rate in patients with recurrent implantation failure (RIF).


Prospective cohort study.


Single private center.


A total of 171 women with RIF divided into two groups: freeze-all policy group (n = 81) and fresh embryo transfer (ET) group (n = 90).


Freeze-all policy.

Main Outcome Measure(s)

Ongoing pregnancy rate.


The clinical pregnancy rate (52% vs. 28%; odds ratio [OR] 1.86; 95% confidence interval [CI], 1.29–2.68) and ongoing pregnancy rate (44% vs. 20%; OR 2.2; 95% CI, 1.04–3.45) were statistically significantly higher in the freeze-all group than the fresh ET group, respectively. The implantation rate was also statistically significant (freeze-all group 44.2% vs. fresh ET group 15.8%; OR 2.80; 95% CI, 2.00–3.92).


The freeze-all policy statistically significantly improved the ongoing pregnancy and implantation rates. Thus, a freeze-all policy is likely to be the new key to helping open the black box of RIF. These findings also are useful for further investigating the adverse effect of controlled ovarian stimulation on in vitro fertilization outcomes.

Read the full text here.


Go to the profile of Ben Willem J. Mol
about 3 years ago

Dear editor, dear authors,

With interest I read the article of Magdi et al. This study is labelled as a prospective cohort study in the abstract and in the full text. "This prospective cohort study was conducted at a specialized fertility and gynecology center from April 2014 to October 2016. "

In the text the authors write "A total of 171 women with RIF were randomly assigned on the day of oocyte retrieval by use of a computer-based Microsoft Excel spreadsheet into two groups: ...."

Could the authors explain what has happened here. 

Was this an RCT or not?


Professor Ben Mol 



Professor of Obstetrics and Gynaecology

NHMRC Practitioner fellow




Department of Obstetrics and Gynaecology Monash University Monash Medical Centre

246 Clayton Road

Clayton Victoria 3168



Go to the profile of Yasmin Magdi
over 2 years ago

Thanks Prof. Ben for your comment

It is not RCT.

Go to the profile of Yasmin Magdi
over 2 years ago

In View of some questions about our study, we performed a re-analysis. Although the main final outcome data turned out to be robust, there was a discrepancy in the baseline data on female age and BMI in the published article and the original dataset re-analyzed by Madelon van Wely & Rik van Eekelen.






Fresh n=90

Frozen n=81

Fresh n=90

Frozen n=81








Female age

31.18 (SD 3.41)

31.47 (SD 2.55)

30.18 (SD 3.41)

31.47 (SD 2.55)

p for difference: 0.005


26.72 (SD 2.19)

27.11 (SD 2.26)

26.02 (SD 2.19)

27.11 (SD 2.26)

p for difference: 0.002

Also, there exists a difference in the number of multiple pregnancies between the paper and the data as follow:

Multiples (Sac variable?)




23 (including a quadruplet...)