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We treated chronic endometritis with antibiotics, aberrant high Th1\/Th2 cell ratios with vitamin D and\/or tacrolimus intake, overt\/subclinical hypothyroidism with levothyroxine, and thrombophilia with low\u2010dose aspirin. Of the 116 RIF women, 88 women with 133 ET cycles were recruited from a questionnaire\u2010based survey regarding pregnancy outcomes. Fifty\u2010nine consecutive RIF patients without the OPTIMUM treatment strategy were also recruited as a control.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The 116 women with RIF after the OPTIMUM treatment strategy were 38.3\u00a0\u00b1\u00a03.8\u00a0years old and had an implantation failure history over 5 (3\u201019) ET cycles. Implantation testing identified impaired intrauterine circumstances in 75 women (64.7%), an aberrant elevated Th1\/Th2 cell ratio in 56 women (48.3%), and thyroid abnormalities in 33 women (28.4%). Cumulative ongoing pregnancy rates including spontaneous pregnancy in the patients aged\u00a0&lt;\u00a040 and\u00a0\u2265\u00a040\u00a0years were 72.7% and 45.5% within two ET cycles, respectively. The pregnancy outcomes in the OPTIMUM group were significantly higher than those in the control.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The OPTIMUM treatment strategy improved pregnancy outcomes in patients with RIF.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aji.13376","type":"journal-article","created":{"date-parts":[[2020,11,9]],"date-time":"2020-11-09T20:40:42Z","timestamp":1604954442000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Analysis of the risk factors and treatment for repeated implantation failure: OPtimization of Thyroid function, IMmunity, and Uterine Milieu (OPTIMUM) treatment strategy"],"prefix":"10.1111","volume":"85","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2759-9159","authenticated-orcid":false,"given":"Keiji","family":"Kuroda","sequence":"first","affiliation":[{"name":"Center for Reproductive Medicine and Implantation Research Sugiyama Clinic 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