title: Two-year outcome after recurrent implantation failure: prognostic factors and additional interventions.
abstract: OBJECTIVE
  After recurrent implantation failure (RIF), empirical figures on further prospects are essential for counselling but difficult to estimate within single IVF centres due to high drop-out rates. Alternatively, couples referred to a tertiary unit for RIF were evaluated.
  
  
  METHODS
  Multi-centre 2-year observational trial of 1,174 eligible couples treated consecutively with adjuvant lymphocyte immunotherapy (LIT) in a university immunological department from 1999 to 2002 after three or more unsuccessful fresh embryo transfers. Acquisition of data was completed in 2005.
  
  
  RESULTS
  With another 1.5 oocyte retrievals, delivery rate per couple depended on age (39.3% at <30 years, 16.9% at >39 years, P < 0.005). Prognosis was favourable when frozen embryo transfers had been conducted before (34.4 vs. 25.8%, P < 0.005). The outcome was slightly better in ICSI couples as compared to conventional IVF (31.0 vs. 24.8%, P < 0.05). Birth rates per fresh embryo transfer from the fourth to eighth retrieval were 17.4-18.3-15.0-12.9-12.9% (decline not significant). Apart from LIT, further additional interventions were given more often to couples who had had frozen embryo transfers before (49 vs. 40%, P < 0.005).
  
  
  CONCLUSIONS
  Female age and ovarian response are crucial for further IVF prognosis. Previous frozen embryo transfers indicate better chances. Couples with male factor infertility may benefit from intracytoplasmatic sperm injection (ICSI) because underlying female factors are less prevalent. Cycle rank had comparatively little impact. Additional interventions are preferentially offered to couples who have a favourable prognosis anyway. Their multiple use is common practice in RIF, but its value should be considered limited.
authors.affiliation: Institute of Immunology, University Medical Center Schleswig-Holstein, Michaelisstr. 5, 24105 Kiel, Germany. kling@immunologie.uni-kiel.de
authors.forename: Christiane
authors.initials: C
authors.lastname: Kling
authors.forename: Andreas
authors.initials: A
authors.lastname: Schmutzler
authors.forename: Georg
authors.initials: G
authors.lastname: Wilke
authors.forename: Jürgen
authors.initials: J
authors.lastname: Hedderich
authors.forename: Dieter
authors.initials: D
authors.lastname: Kabelitz
mesh_terms: D000328:Adult; D010064:Embryo Implantation; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007167:Immunotherapy; D007247:Infertility, Female / Q000628:therapy*; D007248:Infertility, Male / Q000628:therapy*; D008214:Lymphocytes / Q000276:immunology; D008297:Male; D011247:Pregnancy; D011379:Prognosis; D020554:Sperm Injections, Intracytoplasmic; D017211:Treatment Failure; D016896:Treatment Outcome