Recurrent implantation failure in the setting of severe endometriosis : : case report

Repeated failure to conceive following the transfer of good quality embryos into a normal uterus over at least two in vitro fertilisation (IVF) or intra-cytoplasmic sperm injection (ICSI) cycles defines the notion of recurrent implantation failure (RIF). The true incidence of recurrent implantation failure (RIF) is unknown. The causes can broadly be divided into embryo related and maternal causes. Whereas each cause affects implantation on its own right, recent evidence suggest that perturbation of endometrial receptivity may be the final common pathway by which implantation fails for most factors associated with recurrent implantation failure. Endometriosis is a chronic debilitating condition associated with chronic pelvic pain and subfertility in 50% of the cases. It is associated with disrupting markers of endometrial receptivity, and in 50% of cases despite assisted reproductive technology, patients remain infertile. We report a patient with severe endometriosis who underwent laparoscopic ablation and resection with good results and patent tubes. Despite her partner's normal semen analysis she could not conceive with repeated IVF attempts ultimately developing poor ovarian response and premature ovarian insufficiency. Attempts to conceive with donor oocytes were also met with failure. The advent of the endometrial receptivity array test that identifies personalised window of implantation may offer hope for patients with RIF, thereby allowing personalised embryo transfer and conception.