Recurrent Implantation Failure in IVF | Prof. Dr. İkbal Kaygusuz

Recurrent Implantation Failure: Why Does IVF Not Work?

Prof. Dr. İkbal Kaygusuz Last reviewed: 25 September 2026 2 min read

In short: Recurrent implantation failure means no pregnancy despite several transfers of good-quality embryos. Chromosomal problems in the embryo, uterine polyps, septum or adhesions, endometrial receptivity, fluid in the tubes (hydrosalpinx) and maternal age are the main factors. Assessment covers both the embryo and the uterus.

What is implantation?

Implantation is when the embryo attaches to the uterine lining and begins to develop. It needs both a healthy embryo and a receptive lining. Repeated failure despite good embryos is distressing and calls for a systematic search for causes.

Causes

Embryo factors

Many embryos that look good under the microscope, especially at older maternal ages, have chromosomal abnormalities and fail to implant or miscarry early. Preimplantation genetic testing (PGT-A) may be considered for selected patients.

Uterine factors

Polyps, submucosal fibroids or a septum
Intrauterine adhesions (Asherman syndrome)
Chronic endometritis
A thin endometrium
Hydrosalpinx (fluid in the tubes), which can be toxic to embryos

Other factors

Thyroid disorders, antiphospholipid syndrome, obesity and smoking can also affect implantation, and the role of sperm DNA damage is being studied.

Assessment and treatment

Assessment includes a review of previous treatments, hysteroscopy, ultrasound for hydrosalpinx and, when needed, chromosome analysis and hormone tests. Correcting a problem, such as removing a polyp or septum or blocking tubes with hydrosalpinx, can improve the chance of the next transfer. Many add-on treatments lack sufficient evidence and are not routinely recommended; the plan follows current evidence.

Frequently Asked Questions

After how many failed transfers should we investigate?

Usually after at least three transfers of good-quality embryos, or a number adjusted to the woman's age.

Does hysteroscopy improve IVF success?

If a polyp, septum or adhesions are present, treating them can help. Routine hysteroscopy has not been shown to help when the uterus is normal.

Sources

The information on this website is for general information only and does not replace a medical consultation.

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