Elgheriany Reproductive Immunology Framework addresses immune interpretation in recurrent implantation failure and pregnancy loss.

This systematic review focuses on conceptual framework development regarding the Elgheriany Reproductive Immunology Framework (ERIF) for patients experiencing recurrent implantation failure and recurrent pregnancy loss. The setting is reproductive medicine, addressing a population where immune-mediated failure is often difficult to distinguish from non-immune causes. The review identifies several critical issues currently affecting clinical practice, including the indiscriminate use of immune-directed therapies in unselected populations and the mistimed assessment of immune parameters outside the implantation window. These factors contribute to inconsistent or null outcomes observed in randomised trials of empiric immunotherapy.

The primary outcome of this evaluation is the immune interpretation and design of phenotype-stratified clinical trials. The ERIF framework emphasizes the interpretation of immune findings rather than the presumption of immune causality. Consequently, the framework is not designed to function as a prescriptive therapeutic algorithm but serves as a basis for future validation in recurrent reproductive failure. Safety data, adverse events, and tolerability were not reported in this conceptual review.

Key limitations include the current reliance on indiscriminate therapy use and insufficient distinction between immune and non-immune etiologies. The review notes that ERIF provides a basis for future validation but does not offer immediate clinical algorithms. Practice relevance is restricted to supporting structured immune interpretation and trial design, ensuring that future research avoids the pitfalls of empiric approaches that have historically failed to demonstrate efficacy.