Hossam Elzeiny: Distinguishing Recurrent IVF Failure from True Recurrent Implantation Failure
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:
“It was a privilege to be invited as a guest author to the USF Journal Club this week to discuss our recent paper, ‘Recurrent implantation failure: a registry-corroborated, age-stratified definition and pragmatic five-tiered management algorithm’ (Frontiers in Endocrinology, 2026), and I thoroughly enjoyed the evening.
When good-quality embryos repeatedly fail to implant, patients and clinicians are often left without clear answers. The ABCDE framework offers a memorable, bedside definition of recurrent implantation failure, setting how many failed transfers should precede the diagnosis according to the patient’s age and embryo quality. Its thresholds are derived from registry data from the United States, Australia, New Zealand and Europe, but they now require validation in prospective studies. A five-tier management pathway follows, and we hope the framework can serve as a common definition for future research.
The discussion was rigorous and generous in equal measure. A central theme was the distinction between recurrent IVF failure and true recurrent implantation failure, which is essential to avoid mislabelling patients and directing them towards unnecessary investigations. The fellows’ questions on how the clinical criteria interact, how fresh and frozen cycles should be counted, and where biochemical pregnancy belongs went straight to the practical questions clinicians face every day.
My sincere thanks to Dr. Brad Swelstad for chairing, to Dr. Mary Hinckley, Dr. Lusine Aghajanova and Dr. Shayne Plosker, and to Stanford REI fellows Dr. Emily Frisch and Dr. Mackenzie Norton Naert for an outstanding presentation and critique.
I am equally grateful to my co-authors, Dr. Alexander Quaas, Professor Alexandra Bielfeld, and Dr. Michael Costello, for a truly international collaboration.
Journal clubs like this are where frameworks are properly tested. I look forward to continuing the conversation.”
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.
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