Concierge reproductive medicine · London
Implantation failure and recurrent miscarriage workup, structured NICE / ESHRE-aligned investigation.
A structured NICE and ESHRE-aligned workup for repeated implantation failure and repeated miscarriage. It looks at the shape of the uterus, hormones, blood clotting, immune factors, genetics, and the reproductive microbiome. The findings feed a treatment plan built for you.
Key facts
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Definition
A structured workup for repeated implantation failure and repeated miscarriage.
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When
Investigates ≥ 3 miscarriages or ≥ 3 failed euploid transfers.
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Dimensions
Uterine, endocrine, thrombophilia, immunology, genetic and microbiome factors.
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Aligned to
NICE, ESHRE and RCOG guidance.
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Team
Multi-disciplinary fertility team.
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Outcome
A personalised treatment plan.
Preparation and pathway
From first consultation to a full workup — what happens, in order.
A structured seven-step pathway across the six workup dimensions, most of it completed within four to six weeks.
- 01
Fertility specialist consultation
A dedicated consultation with a subspecialist in reproductive medicine to map the picture.
- 02
Detailed reproductive history
Cycle history, obstetric losses, previous transfers, partner factors and family history.
- 03
Pelvic ultrasound + saline sonogram / HyCoSy
3D pelvic ultrasound with saline infusion or HyCoSy to map the cavity and tubes.
- 04
Uterine cavity assessment (hysteroscopy)
Diagnostic hysteroscopy for direct visualisation of the endometrial cavity.
- 05
Endocrine, thrombophilia, immunology bloods
Thyroid, prolactin, HbA1c, antiphospholipid antibodies, inherited thrombophilia screen and immunology.
- 06
Endometrial receptivity array (ERA) if indicated
Molecular assessment of the window of implantation when repeated euploid transfers have failed.
- 07
Karyotype and single-gene testing
Parental karyotype and, where appropriate, single-gene and PGT-A pathways.
What it shows
The named causes the workup identifies.
The workup separates identifiable, treatable causes from unexplained recurrence — across structure, hormones, clotting, immunology, genetics and the endometrial microbiome.
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Uterine anomalies (septum, fibroid, polyp)
Structural causes identified on ultrasound or hysteroscopy.
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Antiphospholipid syndrome (thrombophilia)
Immunological cause of recurrent loss — treatable with aspirin and heparin.
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Thyroid dysfunction
Untreated hypo- or hyperthyroidism materially raises miscarriage risk.
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Chronic endometritis
Persistent low-grade endometrial inflammation — often silent, often treatable.
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Genetic causes (translocations)
Balanced parental translocations can drive recurrent loss.
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Endometrial receptivity issues
A displaced window of implantation identified by ERA testing.
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Microbiome imbalance (EMMA / ALICE)
An endometrial microbiome shifted away from lactobacillus-dominant flora.
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Red flag: antiphospholipid syndrome with thrombosis — haematology urgent review
Do not delay. Urgent haematology review is required.
Treatment options and next steps
A personalised, cause-specific treatment plan.
Treatment is chosen against a named cause — not a blanket protocol — with MDT input across reproductive medicine, haematology, endocrinology and genetics.
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Hysteroscopic septoplasty / polypectomy
Surgical correction of a uterine septum, polyp or focal fibroid distorting the cavity.
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Aspirin / heparin for antiphospholipid syndrome
Low-dose aspirin with low-molecular-weight heparin for confirmed APS in pregnancy.
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Levothyroxine for hypothyroidism
Replacement dosed to a TSH target appropriate for conception and pregnancy.
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Antibiotics for chronic endometritis
Targeted antibiotic course guided by biopsy and CD138 immunohistochemistry.
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Personalised embryo transfer (ERA)
Transfer timed to an individualised window of implantation from ERA results.
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Preimplantation genetic testing (PGT)
PGT-A or PGT-SR pathway where genetic causes are identified.
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Immunomodulation (specialist selective)
Selective, evidence-graded immunomodulation — used sparingly, always by a specialist.
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Multi-disciplinary fertility MDT
A joint plan across reproductive medicine, haematology, endocrinology and genetics.
Our vetted London network
A small panel of clinics, we picked them.
Reproductive-medicine subspecialists across central London. Not listed publicly — introductions are made privately, once we understand your case.
Selection criteria
How we choose every clinic in our network.
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Subspecialist consultants in reproductive medicine
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On-site hysteroscopy and 3D ultrasound with saline / HyCoSy capability
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Access to ERA, EMMA and ALICE endometrial testing
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Multi-disciplinary review across haematology, endocrinology and genetics
Red flags and safety
The findings we treat as urgent.
A short list of findings that materially change what should happen next — some need urgent onward review, others need optimisation before the next transfer.
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Antiphospholipid syndrome
A confirmed APS diagnosis in pregnancy needs aspirin and heparin, and haematology input.
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Uterine septum
A significant septum is a treatable structural cause of recurrent loss.
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Chronic endometritis
Silent, often missed — a treatable driver of recurrent implantation failure.
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Balanced translocations
Parental karyotype identifies couples for whom PGT-SR changes the plan.
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Recurrent hydrosalpinx
A dilated, fluid-filled tube materially lowers implantation and needs treatment before transfer.
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Untreated thyroid disease
Optimise thyroid function before and during pregnancy.
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Poor ovarian reserve
AMH and antral follicle count shape the realistic treatment options.
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Sperm DNA fragmentation
A partner factor that can drive recurrent loss — testable and often modifiable.
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Untreated diabetes
Pre-conception glycaemic control matters — HbA1c should be optimised before transfer.
Reading your report
A recurrent-loss workup can look overwhelming. It doesn’t need to.
Whatever the findings, the report keeps to the same four parts.
A quiet reminder
The report is written for your specialist — and that’s normal.
If you would like us to talk you through it before your follow-up, just ask.
- 01 Header
History and reproductive summary
Your reproductive history, previous losses and cycle context.
- 02 Findings
Uterine, endocrine, immunology, genetics
Vessel-by-organ system findings across all six workup dimensions.
- 03 Assessment
Contributing factors identified
The specific, named factors judged to contribute to recurrent loss.
- 04 Plan
Personalised treatment plan
The named next steps — from surgery to medication to transfer timing.
Recognised by major UK insurers
Cover depends on your policy and clinic; we confirm with your insurer before booking.
Frequently asked
Everything we get asked about the workup.
Quick answers on definitions, ERA, timelines and what happens after the workup.
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What counts as recurrent implantation failure?
Recurrent implantation failure is generally defined as failure to achieve a clinical pregnancy after three or more transfers of good-quality embryos, including euploid transfers. Definitions vary, and the workup we offer is aligned to ESHRE guidance.
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What counts as recurrent miscarriage?
RCOG defines recurrent miscarriage as the loss of three or more consecutive pregnancies. Some services investigate after two losses — particularly with advanced maternal age or a second-trimester loss.
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What does the workup actually cover?
Six dimensions: uterine anatomy, endocrine, thrombophilia and immunology, genetic factors, endometrial receptivity, and the endometrial microbiome — aligned to NICE, ESHRE and RCOG guidance.
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Is an ERA test always needed?
No. ERA is selective — most useful in patients with repeated failed transfers of good-quality euploid embryos, when receptivity timing is a plausible explanation.
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How long does the full workup take?
Most of the investigations can be completed within four to six weeks. Some tests are cycle-dependent, and hysteroscopy or specialist reviews may extend the timeline.
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What happens after the workup?
You receive a personalised treatment plan from the multi-disciplinary team — a named list of the next steps, from surgery and medication to individualised transfer timing.
Sources
What this guide is based on.
- NICE. Fertility problems: assessment and treatment (CG156).
- RCOG. Green-top Guideline No. 17: Recurrent miscarriage.
- ESHRE. Guideline on recurrent pregnancy loss.
- British Fertility Society.
Reviewed by Pulse Atlas Editorial Board (). Last reviewed 2026-07-30. Next review 2027-07-30. Reading time approx. 7 min.
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In practice, in London
The London pathway for implantation failure miscarriage
With implantation failure miscarriage, the London question is usually about report turnaround and the radiologist reading it — not whether the scan is available. Public provision for implantation failure miscarriage is competent but constrained by capacity. Private London clinics tend to have shorter diaries and longer appointment slots, so you get the same specialists with more time. For people who’ve been going round in circles with primary care, that first proper conversation is often what shifts things.
Once you’re in the private system for implantation failure miscarriage, the pace picks up noticeably. Consultant slots run to time, imaging is usually available in the same building or a short walk away, and the report comes back typed and detailed. It’s the coordination that tends to feel different — one person on the other end of the phone, not a switchboard. For implantation failure miscarriage specifically, the difference between a routine report and a sub-speciality read is where private care earns its keep.
Fit matters more than people expect. For implantation failure miscarriage, the right consultant depends on what you actually need — a second opinion, a definitive diagnosis, a bridge into treatment, or reassurance that nothing’s being missed. We match on that, not on who has the biggest brochure. If a test isn’t the right next step, we’ll say so before you book anything.