title: Investigation and current management of recurrent IVF treatment failure in the UK.
abstract: OBJECTIVE
  To determine current practice in the management of recurrent in vitro fertilisation (IVF) treatment failure in licensed UK infertility centres.
  
  
  METHODS
  National postal questionnaire study and literature review.
  
  
  METHODS
  University Hospital, Centre for Reproductive Medicine, Coventry, UK.
  
  
  METHODS
  Human Fertilisation and Embryology Authority licensed centres providing IVF/intracytoplasmic sperm injection (ICSI) in the UK (n = 79).
  
  
  METHODS
  A survey was designed that sought to determine how recurrent treatment failure was defined and which, if any, investigations were initiated. Furthermore, we asked which therapeutic options were subsequently recommended.
  
  
  METHODS
  Definition of recurrent treatment failure. Investigations undertaken. Clinical or embryology changes recommended following recurrent treatment failure.
  
  
  RESULTS
  The response rate was 82%. The most common definition was three unsuccessful IVF cycles (range 2-6). Nineteen percent included frozen embryo replacements (FERs) in this figure. Anticardiolipin antibodies and lupus anticoagulant were the most frequent investigations suggested, followed by hysteroscopy and karyotype. A majority of centres would use a different treatment strategy in a subsequent cycle with blastocyst culture and assisted hatching being most popular.
  
  
  CONCLUSIONS
  The results of this survey suggest that there is considerable variation in the approach to investigation and management of recurrent IVF treatment failure in the UK, although in some areas (e.g. the definition) there was broad concordance. Not all of these approaches are evidence based.
authors.affiliation: Centre for Reproductive Medicine, University Hospitals Coventry and Warwickshire NHS Trust, UK.
authors.forename: Bee K
authors.initials: BK
authors.lastname: Tan
authors.forename: Patrick
authors.initials: P
authors.lastname: Vandekerckhove
authors.forename: Richard
authors.initials: R
authors.lastname: Kennedy
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Keay
mesh_terms: D000328:Adult; D017153:Antibodies, Anticardiolipin / Q000032:analysis; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D006801:Humans; D015907:Hysteroscopy / Q000379:methods; D007247:Infertility, Female / Q000628:therapy*; D007248:Infertility, Male / Q000628:therapy*; D007621:Karyotyping; D016682:Lupus Coagulation Inhibitor / Q000032:analysis; D008297:Male; D012008:Recurrence; D017211:Treatment Failure
chemical_list: D017153:Antibodies, Anticardiolipin; D016682:Lupus Coagulation Inhibitor