You've transferred good-looking embryos — maybe two, maybe three, maybe more — and none have implanted. Each failed transfer is emotionally devastating, financially draining, and medically confounding. At what point do you stop repeating the same protocol and start investigating why?
Recurrent implantation failure (RIF) is generally defined as failure to achieve pregnancy after transferring at least 3 good-quality embryos (or 2 euploid embryos) across multiple cycles. If you're at that threshold, here's the systematic workup that should happen before your next transfer.
The RIF Investigation Framework
| Category | Tests / Evaluations | What It's Looking For | Colombia Cost |
|---|---|---|---|
| Uterine anatomy | Hysteroscopy, saline sonogram, MRI if needed | Polyps, fibroids, septum, adhesions, adenomyosis | $150–$500 |
| Endometrial receptivity | ERA biopsy, endometrial thickness monitoring | Implantation window timing (controversial) | $500–$1,000 |
| Thrombophilia / clotting | Antiphospholipid antibodies, Factor V Leiden, protein C/S, homocysteine | Blood clotting disorders affecting placentation | $100–$300 |
| Immunological (basic) | NK cell assay, thyroid antibodies (TPO/TG) | Autoimmune factors potentially affecting implantation | $100–$300 |
| Endocrine | Thyroid panel, prolactin, insulin resistance | Subclinical thyroid disease, metabolic factors | $50–$150 |
| Male factor review | Sperm DNA fragmentation (DFI), FISH analysis | Sperm quality beyond standard semen analysis | $200–$500 |
| Embryo quality audit | Review lab data: blastocyst grading, PGT-A results | Were embryos truly high-quality? Reevaluate grading criteria | Included in consult |
| Chronic endometritis | Endometrial biopsy with CD138 staining | Subclinical uterine infection affecting implantation | $100–$300 |
The Most Commonly Missed Diagnoses
Chronic endometritis. A low-grade bacterial infection of the uterine lining that produces no symptoms but reduces implantation rates by 30–50%. Diagnosed by endometrial biopsy with CD138 immunostaining (looking for plasma cells). Treated with a 14-day course of antibiotics. Simple, cheap, and frequently overlooked — yet it's one of the most fixable causes of RIF.
Subclinical hypothyroidism. TSH levels between 2.5 and 4.0 mIU/L — "normal" by standard lab ranges but suboptimal for implantation. Many reproductive endocrinologists supplement with levothyroxine to bring TSH below 2.5 before transfer. The thyroid panel costs $30–$50 in Colombia.
Uterine pathology. Small polyps and adhesions that don't show on standard ultrasound but are visible on hysteroscopy. An office hysteroscopy in Colombia costs $150–$300 and takes 15 minutes. It should be standard before any RIF investigation — not an afterthought.
Why Colombia for a RIF Workup
The same tests that cost $3,000–$5,000 at a U.S. fertility clinic run $500–$1,500 in Colombia. More importantly, Colombian reproductive endocrinologists at established fertility centers have extensive experience with RIF patients — many of whom are medical tourists who've already failed multiple cycles at U.S. clinics. A fresh set of eyes, a systematic re-evaluation, and a different protocol philosophy can break the pattern.
Struggling with Recurrent Implantation Failure?
Send us your cycle history and previous test results. We'll connect you with a Colombian RE who specializes in RIF workups and protocol redesign.
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