Recurrent Implantation Failure (RIF)

Starting a family is a deep and meaningful dream for many. However, when embryo implantation repeatedly fails despite proper medical support, the disappointment is intense, and the need for answers becomes urgent. The FertUlity team stands by your side during this challenge, offering expert guidance and meaningful care.

What Is Recurrent Implantation Failure or RIF?

Recurrent Implantation Failure (RIF) refers to the inability to achieve pregnancy after the transfer of good-quality embryos in at least two or three IVF cycles. It is not a simple failed cycle, but a complex phenomenon that requires individualized analysis and intervention.

Why Does RIF Occur

RIF is a multifactorial issue and often there is not just one explanation. Possible causes include:

Uterine factors

Anatomical anomalies such as septa, polyps, adhesions, or submucosal fibroids may hinder implantation. Detailed evaluation through hysteroscopy or hysterosalpingo-contrast sonography (HyCoSy) can reveal uterine abnormalities.

Endometrial quality

Endometrial receptivity and its synchronization with the luteal phase are critical. Tests such as the ERA test (Endometrial Receptivity Analysis) provide valuable insight into the endometrial profile.

Immunological and thrombophilic factors

Disorders of the immune system or blood clotting parameters – such as antiphospholipid syndrome or thrombophilias – are linked to failed implantations.

Chromosomal abnormalities

Genetic anomalies in sperm or eggs, as well as embryonic chromosomal imbalances, are key contributors to implantation failure.

Sperm and microenvironment

Sperm quality analysis via DNA fragmentation testing, FISH test, and other advanced male fertility evaluations are essential, as good morphology alone is not always enough for successful implantation.

Uterine microbiome and inflammation

The presence of non-beneficial bacteria, chronic endometritis, or subclinical inflammation can impair the endometrium’s ability to accept the embryo.

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How Is It Diagnosed

Our approach is holistic and includes:

Detailed history of failed IVF cycles

Hysteroscopy and Hysterosalpingo-contrast sonography (HyCoSy)

Hormonal and blood testing (AMH, FSH, AFC, thrombophilia, etc.)

Immune testing (NK Cells, HLA compatibility, cytokines)

ERA, EMMA, ALICE tests for endometrial and microbiome evaluation

Sperm quality analysis through advanced male fertility testing

Genetic testing of the couple and/or preimplantation genetic testing of embryos (PGT-A)

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What Is the Therapeutic Approach to RIF

There is no "one-size-fits-all" solution. Every infertility story is unique, just like every treatment plan we design. The therapeutic approach to RIF is based on diagnostic findings and tailored to the couple’s needs, aiming not just for technical success, but for a sustainable, healthy, and peaceful pregnancy.

When anatomical barriers in the uterus are identified, minimally invasive procedures such as hysteroscopic polyp removal or adhesion correction are performed. In cases of hormonal or immunological imbalance, targeted medication is recommended to restore balance and prepare the endometrium ideally. Chronic inflammation or microbial imbalances are treated with targeted antibiotic or anti-inflammatory therapy, creating a favorable microenvironment for implantation.

Choosing the right type of cycle – natural, modified, or hormonally supported – plays a significant role. At the same time, special supportive treatments like intralipids, corticosteroids, or low molecular weight heparin are administered to enhance endometrial receptivity and reduce potential immune attacks on the embryo. In cases of suspected chromosomal causes, preimplantation genetic testing (PGT-A) is used to select euploid embryos with the highest chances of success.

Can the Outcome Be Changed? Yes.

Recurrent implantation failure is undeniably a difficult experience, but science has made great strides. At FertUlity, we have proven many times that even the most challenging and complex cases of repeated failed implantations can be reversed with patience, knowledge, and targeted interventions. There are many couples who, after years of failed attempts, finally held their child in their arms.
So yes, there is hope. And that hope is backed by data: with proper diagnosis, the right tests, and a human-centered approach, success rates increase dramatically. At FertUlity, we don’t just focus on the results – we see the person behind them. Our goal is to offer diagnostic precision, treatment depth, and honest communication. We stand by you with empathy, hope, and action.

Frequently Asked Questions About Sperm Quality Analysis

How many failed implantations are required to diagnose RIF?

RIF is usually diagnosed after at least 2–3 IVF cycles with good-quality embryo transfers that do not lead to pregnancy. However, each case is evaluated individually, depending on the patient’s age, history, and number of available embryos.

Can I get pregnant naturally if I have RIF?

Yes, in some cases it is possible. When underlying causes are identified and treated, there are women who manage to conceive naturally without further assisted reproduction. Careful monitoring and support from a specialized team increases the chances.

What’s the difference between RIF and recurrent miscarriage?

The key difference lies in the timing of reproductive failure. In RIF, embryo implantation fails, meaning pregnancy never begins. In contrast, in recurrent miscarriage, pregnancy occurs but ends repeatedly in the early stages. While causes may overlap, different diagnostic and treatment strategies are required.

Does sperm affect implantation?

Absolutely. Even when semen analysis falls within normal parameters, there may be subclinical issues like high DNA fragmentation or genetic abnormalities that impact embryo quality and the ability to implant and develop properly.

Our Doctors

In an era where fertility requires knowledge, care, and substantial guidance, FertUlity is not an impersonal clinic. It is two people who look you in the eye and accompany you step by step on the journey you dream of.

Dr. Maria Oikonomou Obstetrician – Gynecologist

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Dr. Chrysostomos (Makis) Papadopoulos Obstetrician – Gynecologist, MD, PhDc, MIC I

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The First Step Starts Now

You don’t need to have all the answers to begin.
All it takes is one first step, and a team that truly listens.

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Why choose FertUlity?

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At FertUlity, we provide science-based fertility care with a human approach.
We support every path, from fertility assessment and preservation to modern assisted reproduction.