Endometrial disruption does not improve implantation in patients who have failed the transfer of euploid blastocysts.

Marie D Werner,Paul A Bergh,Richard T Scott,Jason M Franasiak,Eric J Forman,Kathleen H Hong

doi:10.1007/s10815-015-0435-0

Abstract

PurposeTo assess the impact of single pass outpatient endometrial biopsy in patients at the highest risk for an endometrial cause for failed implantation; those that have failed to conceive despite the transfer of morphologically normal euploid embryos.MethodsThis is a retrospective cohort study consisting of all patients less than 42 years old who failed their first euploid blastocyst transfer and subsequently completed a second transfer cycle of euploid blastocysts. Cycles were analyzed to determine if a single pass endometrial biopsy, termed 'endometrial disruption', was performed in a cycle preceding their second embryo transfer. Transfer outcomes were analyzed and implantation rates calculated. Data analysis was performed to compare outcomes between patients who had endometrial disruption performed versus those that did not.ResultsTwo hundred ninety patients failed their first euploid embryo transfer and subsequently completed a second euploid embryo transfer and were included. Thirty-nine patients underwent endometrial disruption and 251 did not. There were no statistical differences in clinical implantation rate or sustained implantation rate between the group with endometrial disruption and subjects without any intervention (Clinical IR, 43.6 % vs. 55.0 %, p = 0.13; 38.5 % vs. 42.6 %, p = 0.60). When controlling for transfer order there was no statistical difference noted in implantation rates.ConclusionsSingle pass endometrial biopsy has no impact on endometrial receptivity in the highest risk subgroup- patient's that have failed to sustain the transfer of morphologically normal euploid embryos- as evidenced by equivalent implantation rates. It is possible that variations in technique may alter outcomes and randomized trials are needed to answer this question.

Highlights

Implantation is a complicated biochemical process but fundamentally there are two key factors that are essential to successful implantation and establishment of a viable pregnancy: embryonic competence and endometrial receptivity
Single pass endometrial biopsy has no impact on endometrial receptivity in the highest risk subgroup- patient's that have failed to sustain the transfer of morphologically normal euploid embryos- as evidenced by equivalent implantation rates
If single embryo transfer pregnancy rates with advanced selection techniques are as high as 60 %, could the endometrium be culpable for up to 40 % of the failures [3]? Mechanical injury to the endometrium has been purported to enhance endometrial receptivity and improve embryo transfer outcomes, but research utilizing this technique has focused on either the general IVF population or those who have a history of failed implantation [4,5,6,7,8,9]

Summary

Introduction

Implantation is a complicated biochemical process but fundamentally there are two key factors that are essential to successful implantation and establishment of a viable pregnancy: embryonic competence and endometrial receptivity. Over the past decade research has focused on embryonic factors and the selection of morphologically-superior, genetically-normal blastocysts for transfer [1, 2]. That substantial improvements in embryonic culture and enhanced selection techniques have been validated, there is a renewed focus on the potential reasons why high-quality, chromosomally-normal blastocysts do not always implant. Mechanical injury to the endometrium has been purported to enhance endometrial receptivity and improve embryo transfer outcomes, but research utilizing this technique has focused on either the general IVF population or those who have a history of failed implantation [4,5,6,7,8,9]. This study seeks to address whether endometrial disruption improves outcomes in this high-risk population with prior failed euploid transfers

Methods

Results

Conclusion