Recurrent implantation failure — shared decision-making and adjunct counselling station

Communication and shared decision-making station in recurrent implantation failure: tests the ESHRE cumulative-chance definition, evidence-based counselling on PGT-A (STAR, ASRM 2024), endometrial scratch (Cochrane 2026), ERA (Simón 2020) and intralipid, and honest handling of patient-requested unproven adjuncts. Includes assessor key and marking domains.

Prompt

A 38-year-old woman with three failed frozen single-blastocyst transfers sits in your clinic with a list of adjuncts she wants to pay for: PGT-A, endometrial scratch, ERA and intravenous intralipid. She has spent a great deal of money, is emotionally exhausted, and is angry that 'nothing has worked'. You are the reproductive medicine registrar running the consultation.

Station brief

Format. Communication and shared decision-making station, approximately 12 minutes. You are the reproductive medicine registrar. The assessor plays the patient; a second examiner scores. You have the cycle history and the list of adjuncts she has brought.^[1]

Candidate instruction. Conduct the consultation: acknowledge the emotional and financial cost first, define her situation by the ESHRE cumulative-chance model, complete the evidence-based workup, and counsel her on each adjunct using the ESHRE traffic light and the best trial evidence. Verbalise your reasoning and your checks.^[1]^[2]

References6Show

[1]Cimadomo D, de Los Santos MJ, Griesinger G, et al. ESHRE good practice recommendations on recurrent implantation failure Hum Reprod Open, 2023.PMID 37332387
[2]Lundin K, Bentzen JG, Bozdag G, et al. Good practice recommendations on add-ons in reproductive medicine Hum Reprod, 2023.PMID 37747409
[3]Munné S, Kaplan B, Frattarelli JL, et al. Preimplantation genetic testing for aneuploidy versus morphology as selection criteria for single frozen-thawed embryo transfer in good-prognosis patients: a multicenter randomized clinical trial Fertil Steril, 2019.PMID 31551155
[4]Practice Committees of the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology The use of preimplantation genetic testing for aneuploidy: a committee opinion Fertil Steril, 2024.PMID 38762806
[5]Perera AK, Gan J, Afroz A, et al. Endometrial injury in women undergoing in vitro fertilisation (IVF) Cochrane Database Syst Rev, 2026.PMID 42138348
[6]Cimadomo D, Rienzi L, Conforti A, et al. Opening the black box: why do euploid blastocysts fail to implant? A systematic review and meta-analysis Hum Reprod Update, 2023.PMID 37192834

Recurrent implantation failure — shared decision-making and adjunct counselling station

Station brief

References6Show

[1]Cimadomo D, de Los Santos MJ, Griesinger G, et al. ESHRE good practice recommendations on recurrent implantation failure Hum Reprod Open, 2023.PMID 37332387
[2]Lundin K, Bentzen JG, Bozdag G, et al. Good practice recommendations on add-ons in reproductive medicine Hum Reprod, 2023.PMID 37747409
[3]Munné S, Kaplan B, Frattarelli JL, et al. Preimplantation genetic testing for aneuploidy versus morphology as selection criteria for single frozen-thawed embryo transfer in good-prognosis patients: a multicenter randomized clinical trial Fertil Steril, 2019.PMID 31551155
[4]Practice Committees of the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology The use of preimplantation genetic testing for aneuploidy: a committee opinion Fertil Steril, 2024.PMID 38762806
[5]Perera AK, Gan J, Afroz A, et al. Endometrial injury in women undergoing in vitro fertilisation (IVF) Cochrane Database Syst Rev, 2026.PMID 42138348
[6]Cimadomo D, Rienzi L, Conforti A, et al. Opening the black box: why do euploid blastocysts fail to implant? A systematic review and meta-analysis Hum Reprod Update, 2023.PMID 37192834