Hysteroscopic intervention may improve the pregnancy rate in patients with repeated IVF-ET failures

Abstract

Objective: Most embryos that are transferred during an IVF-ET procedure fail to implant for unidentified reasons. The most consistent factor for predicting pregnancy and implantation rates is the quality of the embryos selected for ET. On the other hand, uterine integrity and endometrial receptivity are also determining factors in achieving embryonic implantation. Thus, the presence of benign endometrial pathologies such as endometritis, endometrial polyps, submucous leiomyomata and intrauterine adhesions may adversely influence endometrial receptivity and prevent implantation independently of embryo quality. The aim of this study therefore was to verify the role of diagnostic and therapeutic hysteroscopy in patients with repeated IVF-ET failures in spite of the good quality embryos available for transfer. Design: Prospective, observational study with diagnostic and/or therapeutic intervention. Materials/Methods: A total of 56 patients were included in the study between January 1998 and July 2001. Inclusion criteria of patients were: (1) Two failed ICSI-IVF cycles where (2) a minimum of 2 good-quality embryos (7 or 8 cells with less than 10% fragmentation on day 3) were transferred on each occasion. All patients were submitted to a diagnostic hysteroscopy before the subsequent ICSI cycle. Patients were allocated in 2 groups according to the findings of hysteroscopy: Group 1 (normal uterine cavity; n = 30) and Group 2 (abnormal uterine cavity; n = 26). Abnormal cavity included polyps, submucous leymiomata, intrauterine adhesions and endometritis. A therapeutic intervention was performed when pertinent. Polyps and leyomiomata were resected by resectoscope, adhesions were eliminated and endometritis were treated using doxycycline 100 mg twice a day for 14 days. The outcome of the subsequent ICSI cycle was analyzed in all patients. Laboratory and clinical data were evaluated and compared by the one-way ANOVA test (A) or by the Fisher exact test (B). Results: Relevant clinical and laboratory data are summarized in the table-1. Quality of embryos selected for transfer was similar in the two groups. Three of the 30 women had delivery in the normal cavity group and 5 of the 26 in the abnormal cavity group after intervention (NS).Table 1Relevant clinical and laboratory data on the results of hysteroscopy.GroupsNormal cavity (n = 30)Abnormal cavity (n = 26)PAge of women (+/−SD)36.7 (6.7)38 (5.8)NS (A)Embryos Transferred (+/−SD)3.8 (0.9)3.6 (1.2)NS (A)Clinical Pregnancy (%)6 (20)13 (50)0.02405 (B)Implantation Rate %7%22%0.0022 (B)On-Going Pregnancy35NS (B) Open table in a new tab Conclusions: The results of the present study suggest that there is a relatively high incidence of pathological findings by hysteroscopy in patients with repeated failure(s) of IVF-ET, especially when good-quality embryos are available for transfer. It is also demonstrated that relevant therapeutic interventions resulted in a significantly improved clinical pregnancy and implantation rates in patients with abnormal uterine cavity in contrast to patients with normal uterine cavity. Therefore we may conclude that evaluation of uterine and endometrial integrity by hysteroscopy is highly valuable and should be applied in all cases of infertility with repeated failure of implantation with good-quality embryos. Supported by: Clinica e Centro de Pesquisa em Reproducao Humana Roger Abdelmassih.