{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T09:55:31Z","timestamp":1791194131069,"version":"4.1.0"},"reference-count":162,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:p>Recurrent implantation failure (RIF) remains a significant challenge in reproductive medicine, imposing substantial emotional, clinical, and financial burden on affected couples. RIF is generally defined as failure to achieve pregnancy after multiple transfers of good-quality embryos, yet progress in the field has been constrained by the absence of a universally accepted definition and by the inherent complexity of investigating the embryo\u2013endometrial interface. Recent evidence has prompted a reappraisal of the factors contributing to RIF, distinguishing it from the mechanistically distinct entity of embryo-intrinsic failure (recurrent embryo arrest and poor embryo development). This narrative review synthesises epidemiological data, evaluates the evidence base for available diagnostic modalities, and appraises current management strategies, including the controversies surrounding adjunctive treatments. We propose a registry-corroborated, age-stratified definition of RIF \u2014 the ABCDE framework \u2014 and a five-tiered, clinically applicable management algorithm that integrates the available evidence with expert recommendation to guide clinicians within a shared decision-making framework. Future directions include prospective multicentre validation, incorporation of artificial intelligence for risk prediction, and development of novel therapeutic approaches targeting the embryo\u2013endometrial interface.<\/jats:p>","DOI":"10.3389\/fendo.2026.1930159","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T09:35:01Z","timestamp":1791192901000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Recurrent implantation failure: a registry-corroborated, age-stratified definition and pragmatic five-tiered management algorithm"],"prefix":"10.3389","volume":"17","author":[{"given":"Hossam","family":"Elzeiny","sequence":"first","affiliation":[{"name":"Reproductive Services Unit, City Fertility and The Royal Women\u2019s Hospital","place":["Melbourne, VIC, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander M.","family":"Quaas","sequence":"additional","affiliation":[{"name":"Shady Grove Fertility Center","place":["Solana Beach, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra P.","family":"Bielfeld","sequence":"additional","affiliation":[{"name":"UniKiD \u2013 Department of Reproductive Endocrinology and Reproductive Medicine, University Medical Centre, Heinrich Heine University","place":["D\u00fcsseldorf, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael F.","family":"Costello","sequence":"additional","affiliation":[{"name":"School of Clinical Medicine, University of New South Wales and Monash IVF Sydney","place":["Sydney, NSW, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms25052834","article-title":"When the embryo meets the endometrium: identifying the features required for successful embryo implantation","volume":"25","author":"Lacconi","year":"2024","journal-title":"Int J Mol Sci"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/s1472-6483(10)61014-0","article-title":"Towards better quality research in recurrent implantation failure: standardizing its definition is the first step","volume":"12","author":"El-Toukhy","year":"2006","journal-title":"Reprod BioMed Online"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.rbmo.2013.12.006","article-title":"What exactly do we mean by \u201crecurrent implantation failure\u201d? 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