Immunology Testing for Repeated IVF Failure

If you have had more than one IVF cycle or embryo transfer that did not lead to pregnancy, it is natural to ask whether something in your body is stopping the embryo from implanting. The immune system is one of the questions many couples ask about.

This page explains what immunology testing can and cannot tell you after failed IVF. It covers which tests have reasonable evidence behind them, which tests are not recommended for routine use, and how our specialists decide what is useful for you.

What Is Repeated IVF Failure (Recurrent Implantation Failure)?

Recurrent implantation failure (RIF) means that good-quality embryos have been transferred more than once, and none have implanted to give a positive pregnancy test.

There is no single fixed number that defines it. International guidance from ESHRE (2023) suggests looking at your personal chance of success, based on:

• your age
• embryo quality
• the number of embryos transferred

Further tests are considered only when the failures are more than chance alone would explain.

This matters because one or two failed transfers can happen even when nothing is wrong. Even with good embryos, each transfer has a real chance of not working.

Is the Immune System Usually the Cause?

In most cases, no. The most common reason a good-looking embryo does not implant is a problem within the embryo itself, often a chromosome abnormality. This becomes more likely as age increases.

Other common factors are:

• the uterus (polyps, fibroids, adhesions, a uterine septum)
• fluid-filled fallopian tubes (hydrosalpinx)
• thyroid problems
• sperm quality
• the IVF protocol

Immune factors are one part of a complete evaluation. They are not the first or only thing to check.

That is why at Mamata Fertility Hospital, immunology testing is usually part of a full failed-IVF review, not a stand-alone package. Learn more in our Failed IVF Review and Second Opinion guide.

When May Immunology Testing Be Considered?

Your specialist may suggest immune or related blood tests if:

• you have had repeated failed transfers of good-quality embryos
• you have a personal or family history of autoimmune disease, such as lupus or thyroid disease
• you have a history of blood clots
• you have had recurrent pregnancy loss, in addition to failed transfers
• earlier test results suggest an immune or clotting problem

Tests That May Be Useful

These tests have a clear medical reason behind them. Your doctor will choose based on your history, not test everyone for everything.

These blood tests check for antiphospholipid syndrome (APS). APS is an autoimmune condition that increases the risk of blood clots and pregnancy complications. If the result is positive, the test is repeated after about 12 weeks to confirm. A single positive result is not enough to diagnose APS.

TSH and thyroid antibody (anti-TPO) tests check whether your thyroid is underactive or affected by autoimmune disease. Thyroid problems are common, easy to test for, and treatable. See our Female Hormone Tests and Specialised Fertility Blood Tests.

Depending on your history, your doctor may also suggest:

• Vitamin D levels
• Tests for chronic inflammation of the uterine lining (chronic endometritis). See Endometrial Infection Test.
• Chromosome testing (karyotype) for both partners in selected cases

Tests That Are Not Recommended for Routine Use

You may read online about tests that promise to find a “hidden immune cause.” Current international guidance (ESHRE, 2023) does not recommend the following for routine use after IVF failure:

• Natural killer (NK) cell testing, in blood or the uterine lining
• HLA matching between partners
• Cytokine testing

These tests are not recommended because research has not shown that they reliably predict IVF failure. Treatments based on their results have also not been proven to increase the chance of a baby.

We believe you deserve to know this before spending money, time and hope on a test. If you have been advised one of these tests elsewhere, we are happy to review that advice with you.

How the Tests Are Done

Most tests in this group are simple blood tests.

• Before: your specialist reviews your full IVF history, previous reports and embryo details. Then they decide which tests, if any, make sense.
• Sample: a blood sample is taken at our NABL-accredited lab. It takes a few minutes. Fasting is usually not needed.
• Results: reports are usually ready in [X] days. Some tests, like antiphospholipid antibodies, need a repeat test after about 12 weeks to confirm the result.
• Follow-up: your doctor explains every result with you. A report alone does not tell the full story.

What Your Results Mean

If Results Are Normal

Normal results are useful. They help rule out some causes so your doctor can focus on factors that are more likely, such as:

• embryo chromosome testing
• checking the uterus
• changing the IVF plan

If a Problem Is Found

• Confirmed antiphospholipid syndrome: your doctor will discuss blood-thinning medicines (such as low-dose aspirin and heparin) for a future pregnancy. The decision depends on your full history.
• Thyroid problem: treated with thyroid medicine, with levels rechecked before your next transfer.
• Other findings: treated based on the specific result.

No test result can guarantee that the next cycle will work. Its role is to help your doctor make a better-informed plan.

What Else Is Checked After Repeated IVF Failure?

A complete review usually looks at more than the immune system:

• Embryo: Preimplantation Genetic Testing (PGT-A), PGT-SR when a parent carries a chromosome rearrangement, and Embryo Time-Lapse Monitoring
• Uterus: Uterine Abnormalities Scan (2D/3D), Saline Infusion Sonography, Endometrial Polyps, Adenomyosis Scan, Endometriosis
• Hysteroscopy when needed: Polyp Removal, Septum Removal, Clearing Adhesions
• Male partner: Semen Analysis and Sperm DNA Fragmentation Test
• Treatment plan: your IVF, ICSI or Frozen Embryo Transfer protocol

If you have also experienced repeated pregnancy loss, see Immunology Testing for Repeated Abortions.

Emotional Support After Failed IVF

Repeated IVF failure is emotionally exhausting. Our Counselling Services are available for you and your partner at any stage. Our Nutrition and Wellness team can help you prepare for your next cycle.

Why Get a Failed IVF Review at Mamata Fertility Hospital?

• NABH-accredited hospital with an NABL-accredited lab
• Founded in 1995 by Dr. Mamata Deenadayal
• Specialists review your complete history before suggesting any test
• We tell you which tests are proven, and which are not
• In-house embryology, genetic testing and hysteroscopy, so findings can be acted on in one place
• Support for International Patients

Meet our Fertility Specialists.

Treatment Options Based on Results

Once immune-related issues are diagnosed, our specialists devise a targeted treatment strategy to increase IVF success rates.

1. Immunotherapy

Medications like corticosteroids or intravenous immunoglobulins (IVIG) can help modulate immune activity.

2. Blood Thinner Therapy

Patients with clotting disorders may respond well to anticoagulant medications like aspirin or heparin.

3. Anti-inflammatory Treatment

Drugs such as prednisone or specific cytokine inhibitors are used to create a healthy uterine environment.

4. Intralipid Infusions

This therapy helps suppress overactive NK cells, increasing chances of embryo implantation.

5. Lifestyle Modifications

Nutritional adjustments, stress management, and avoiding immune triggers can positively impact fertility outcomes.

By following a well-coordinated plan based on test results, many patients at Mamata Fertility Hospital achieve successful pregnancies after previous IVF challenges.

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