A review of the pathophysiology of recurrent implantation failure

As the treatment of reproductive disorders has become more successful, the focus on recurrent implantation failure has increased. Punitive etiologies include entities in immunology, genetics, anatomy, hematology, microbiome, and endocrinology.
A review of the pathophysiology of recurrent implantation failure

VOLUME 116, ISSUE 6, P1436-1448


Jason M. Franasiak, M.D., H.C.L.D., Diana Alecsandru, M.D., Ph.D., Eric J. Forman, M.D., H.C.L.D., Laura C. Gemmell, M.D., Jeffrey M. Goldberg, M.D., Natalia Llarena, M.D., Cheri Margolis, M.D., Joop Laven, M.D., Ph.D., Sam Shoenmakers, M.D., Ph.D., Emre Seli, M.D.


Implantation is a critical step in human reproduction. The success of this step is dependent on a competent blastocyst, receptive endometrium, and successful cross talk between the embryonic and maternal interfaces. Recurrent implantation failure is the lack of implantation after the transfer of several embryo transfers. As the success of in vitro fertilization has increased and failures have become more unacceptable for patients and providers, the literature on recurrent implantation failure has increased. While this clinical phenomenon is often encountered, there is not a universally agreed-on definition—something addressed in an earlier portion of this Views and Reviews.


Go to the profile of Pandiyan  Natarajan
9 months ago

What do we expect from an Embryo Transfer?

It is indeed human to expect a pregnancy after every Embryo Transfer. This applies to both the patients and the physicians. However, that is not reality. It is utopian to expect a pregnancy after every Embryo Transfer. The commonest reason for a failed Embryo Transfer is likely to be a, ‘ Defective Embryo.’  The unassisted pregnancy rate per cycle in young couple with a single oocyte is about 25%.  We can only try to be as good as nature, but not better than nature. Multiple Oocytes produced in ART may increase the pregnancy rate, but not to the extent we desire.

Recurrent Implantation failure is a nebulous entity. The definition has changed over time and a recent paper in Fertility and Sterility clearly indicates that it is not as common as has been portrayed earlier. Patients have been subjected to several unproven therapies in the past.

We need to be counseled and counsel the patient that failures are inevitable and are integral to any Assisted Reproduction program. We must accept that and help our patients  face it with equanimity, than waste time, money and emotions on unproven medical and surgical therapies.

Professor Dr Pandiyan Natarajan.

Apollo 24/7,

Professor of Andrology and Reproductive Medicine ( Retired )

Chettinad Academy of Research and Education.