Hossam Elzeiny։ Our Review on RIF Has Been Published in Frontiers in Endocrinology

Hossam Elzeiny, Fertility Specialist and Gynecologist at City Fertility, shared a post on LinkedIn about a paper he co-authored with colleagues published in Frontiers in Endocrinology։

“A paper I have been waiting to share.

Today, our review on recurrent implantation failure has been published in Frontiers in Endocrinology.

‘Recurrent implantation failure (RIF): a registry-corroborated, age-stratified definition and pragmatic five-tiered management algorithm.’

RIF is one of the most challenging and emotionally difficult experiences in reproductive medicine. But perhaps it is time to reconsider the name itself.

The word ‘failure’ can unintentionally place a burden on patients, when implantation is an extraordinarily complex biological process.

RIF terminology should evolve with our understanding – towards language that is scientifically accurate, clinically meaningful and more compassionate.

In this review, we revisit the definition of RIF and propose an age-stratified ABCDE framework, supported by registry-derived reasoning, together with a five-tiered management algorithm designed to provide a pragmatic pathway from foundational optimisation through progressively more complex clinical considerations.

The central challenge is not simply determining what can be tested.
It is determining what is clinically meaningful.

The intention was not to create another list of investigations.
It was to create a way of thinking.

Importantly, the framework also acknowledges the boundaries of current evidence.
Not every plausible mechanism has a validated diagnostic test.

Not every abnormal result warrants treatment.

And not every unsuccessful embryo transfer represents the same biological problem.
The full article explores these issues in considerably more depth, and I hope it will prompt thoughtful discussion among clinicians and researchers working in reproductive medicine.

This work took approximately a year to synthesise, refine and bring together.

My sincere thanks to my co-authors, Alexander Quaas, Alexandra P. Bielfeld and Michael F. Costello, for their important contributions to this project and for the many discussions that shaped the final manuscript.

I am equally grateful to the reviewers for their thorough and rigorous review. Their critical comments and constructive suggestions substantially strengthened the manuscript and helped bring it to its final form.

Perhaps the most important message is that RIF should not automatically mean ‘more tests’ or ‘more treatment.’ Sometimes, the most important step is to understand what has actually happened before deciding what should happen next.

One line from the paper sums up how I feel about this work:

‘In RIF, compassion is not an adjunct; it is the therapy.’

There is much more in the article than I can put into a LinkedIn post. The paper is now published and available open access.”

Title: Recurrent implantation failure: a registry-corroborated, age-stratified definition and pragmatic five-tiered management algorithm.

Authors: Hossam Elzeiny, Alexander M. Quaas, Alexandra P. Bielfeld, Michael F. Costello.

You can read the Full Article in Frontiers in Endocrinology.

Proceed to the video attached to the post.

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