Assisted reproduction techniques have been used worldwide to treat infertility for over 30 years, but repeated implantation failure (RIF) following various embryo transfers remains an extremely controversial topic.
The special interest group in “Implantation and Early Pregnancy” (SIGIEP) of the European Society of Human Reproduction and Embryology (ESHRE) conducted an international survey to shed light on all possible definitions, methods of investigation and therapies of RIF applied on a global scale.
The survey, whose first author is Danilo Cimadomo, Science and Research manager of GeneraLife IVF, was published in the journal ‘Human Reproduction’.
RIF affects about 5-15% of patients who undergo IVF. But there is still no clear consensus on its definition and, therefore, on its treatment. A situation that involves inconsistencies in the clinical practice, which led the group of experts to investigate in detail the extent of the problem.
The study was carried out between May and June 2020 on 735 doctors and 300 embryologists, called to answer 43 very detailed questions. The majority of the experts define RIF the failure of at least 3 embryo transfers. More than two-thirds of respondents said they consider lifestyle factors, such as drug use, smoking, and body mass index (BMI) to explain RIF, along with chromosomal, endocrinological, and immunological factors. But the highest consensus was reached for the diagnostic investigations to define anatomical malformations and gynecological problems, such as hydrosalpinx, Asherman’s syndrome, endometrial thickness and endometriosis, all considered essential to prevent RIF.
As for the treatment of RIF patients, the experts agree that any precautions should be taken in the pre-conceptional period, and therefore preventively. Specifically, the use of nutritional plans to lose or gain weight, quit smoking, or treat persistent inflammation of the endometrium are considered important.
Extreme variability and disparity of opinions characterizes instead the treatment of RIF during an IVF treatment. “It is essential that the scientific societies find a Consensus on the definition, diagnosis and treatment of RIF. – says Cimadomo – These couples are otherwise highly exposed to the risk of additional treatments, expensive and time-consuming, as well as often poorly validated. Therefore, probably not useful to solve an issue still critical in modern IVF“.