13/09/2026
🔴RIF has never had a universally accepted definition. The ASRM now defines RIF as failure of implantation after transferring enough good-quality blastocysts to reach an expected 95% cumulative chance of a positive pregnancy test.
For euploid embryos, ASRM estimates that RIF may occur after approximately 3–6 failed transfers. In practical terms, this generally means transferring 3–6 euploid embryos, one at a time, in separate transfers, with the cumulative probability of pregnancy increasing with each attempt.
When RIF is suspected, the first step should be a careful review of the patient’s medical history, uterine imaging, previous IVF cycles, embryo quality, and transfer history to identify potential contributing factors.
✅ Investigations or interventions that may be considered:
• Repeat uterine and tubal evaluation
• Parental karyotyping
• PGT-A after repeated failures with untested embryos
• Evaluation and treatment of endometriosis/adenomyosis when clinically indicated
❌ Not routinely recommended for RIF based on current evidence:
• ERA/endometrial receptivity testing
• S***m DNA fragmentation testing
• Endometrial scratching
• Empiric immune treatments
