Is Hysteroscopy Prior to IVF Associated with an Increased Probability of Live Births in Patients with Normal Transvaginal Scan Findings after Their First Failed IVF Trial?

Athanasios Zikopoulos,Eirini Mastora,Apostolia Galani,Charalampos Siristatidis,Maria Paraskevaidi,Efstratios Kolibianakis,Konstantinos Zikopoulos,Ioannis Georgiou

doi:10.3390/jcm11051217

Abstract

(1) Background: Nowadays, pregnancy can be achieved by in vitro fertilisation (IVF) or by intracytoplasmic sperm injection (ICSI) for many infertile couples. However, implantation failure still remains a significant problem and it can be stressful for both patients and doctors. One of the key players for pregnancy achievement is the uterine environment. Hysteroscopy is the most reliable method to evaluate the uterine cavity and to identify any intauterine pathology. The aim of this retrospective study was to compare live birth ranges in between women who after a first failed IVF/ICSI attempt underwent a hysteroscopy and those who were evaluated by a transvaginal scan. (2) The retrospective study took place at the Assisted Reproductive Unit of the University Hospital of Ioannina, Greece, from 2017 to 2020. It included 334 women with normal findings in a repeat ultrasound scan after a failed IVF/ICSI trial, 137 of whom underwent in turn diagnostic hysteroscopy before the next IVF/ICSI. (3) Results: Live birth rates were higher in the study group (58/137 vs. 52/197 p = 0.0025). Abnormal endometrial findings were identified in 30% of the patients of the study group. (4) Conclusions: The addition of hysteroscopy as an additional investigation to those patients with a first failed IVF/ICSI could improve the rates of live births. A properly conducted RCT could lead to a robust answer.

Highlights

Infertility remains a significantly stressful matter for many individuals
The aim of this study was to evaluate whether hysteroscopy in the cycle prior to a second attempt of in vitro fertilisation (IVF)/intra-cytoplasmic sperm injection (ICSI) can lead to a higher probability of pregnancy compared to having no hysteroscopy, in women with a failed first attempt and normal findings at transvaginal sonography (TVS)
While other studies have chosen to study women with recurrent implantation failure (RIF)-study Siri [9], this study focuses on women who have failed to achieve pregnancy after a first unsuccessful IVF/ICSI attempt in order to potentially increase the efficiency of Assisted Reproductive Technology (ART) earlier in the course of treatment, especially when considering how stressful and financially demanding IVF/ICS can be

Summary

Introduction

Infertility remains a significantly stressful matter for many individuals. During the past few decades science has developed ways to handle infertility such as in vitro fertilisation (IVF) and intra-cytoplasmic sperm injection (ICSI). Implantation failure after IVF or ICSI can be quite frustrating for both clinicians and patients. The probability of a pregnancy achievement is approximately 30% [1], while implantation failure may often be associated with uterine cavity abnormalities, such as endometrial polyps, small submucous fibroids, adhesions, and septa [1].

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