Clinical approach to recurrent implantation failure: evidence-based evaluation of the endometrium

After unexplained implantation failure, clinicians should consider an endometrial assessment that yields actionable insights. This optimally would include an assessment of function and screening for endometrial pathology.

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Volume 111, Issue 4, Pages 618–628


Harvey J. Kliman, M.D., Ph.D., David Frankfurter, M.D.b


The endometrium is a dynamic, repetitively cycling tissue that mediates the implantation of the blastocyst. Evaluation of this complex tissue necessitates sophisticated methods that can assess its functional potential. Beginning in the 1950s with simple histological endometrial “dating,” these methods have crossed into the molecular era with the use of arrays aimed at dating, functional tests that assess for proliferation and differentiation, and tests that screen for inflammatory markers. In addition to these specialized tests, histologic evaluation for pathologic conditions—such as growth disorders (i.e. polyps and hyperplasia), inflammatory lesions, and retained products of conception—are critical for a complete assessment of the patient with recurrent implantation failure. Whatever the means of testing, the goal is to reveal actionable findings that can assist in offering the best options to patients who have failed multiple transfers with high quality embryos.

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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders.