Abstract
Purpose of Investigation: To assess better implantation and pregnancy rates following endometrial injury in the presence of previous implantation failure, through a retrospective study in a tertiary University Clinic. The aim of this study is to assess improved embryo implantation after hysteroscopic fundal endometrial injury in repeated implantation failure in patients. Materials and Methods: Twenty-nine women who had recurrent implantation failure participated in the study. They had three or more implantation failures with good quality embryo. Anti-Mullerian hormone (AMH) levels, age, antral follicle count, body mass index, and FSH levels were collected. Frozen/thawed embryos (FTE) were transferred in all subjects. Before embryo transfer the authors performed hysteroscopic endometrial injury by micro cold knife. Results: Median age was 38.62 ± 2.47 years in the study. AMH levels changed between 0.35 and 3.8 ng/ml. The pregnancy rate following hysteroscopy: 17 (58,6%) were pregnant and 12 of 29 subjects did not become pregnant. The women who became pregnant following hysteroscopy were younger and had a higher antral follicle count than the non-pregnant women (p = 0.030 and p = 0.0017 respectively; p < 0.05). Conclusion: The endometrial injury before frozen-thawed embryo transfer had a positive effect on patients who had previous recurrent implantation failure.
Highlights
Infertility has been historically a growing problem in humankind and it may be related to be part of the various medical problems that have increased up to 50% since 1955 in the world [1] and nearly 10-15% of couples who are already suffering from it [2]
The aim of this study is to show improved embryo implantation and pregnancy rates after hysteroscopic fundal endometrial injury
The level of Anti-Mullerian hormone (AMH) was borderline in the pregnant women after hysteroscopy according to the non-pregnant women and it was not statistically significant (p = 0.0568). (Figure 2)
Summary
Infertility has been historically a growing problem in humankind and it may be related to be part of the various medical problems that have increased up to 50% since 1955 in the world [1] and nearly 10-15% of couples who are already suffering from it [2]. Perfect implantation and higher pregnancy rates require the development of high-quality embryos and good endometrial receptivity. Even with better in-vitro fertilization techniques and improving embryo culture conditions, implantation is the still limiting step in the in-vitro fertilization/embryo transfer (IVF-ET) process [3]. Endometrial micro-environmental changes are the most important for implantation of the developing embryo. In humans endometrial receptive period is mid-secretory 1923 days of cycle, which called as window of implantation (WOI). Implantation is very complicated interaction between the embryo and endometrium. Thin endometrium has poor receptivity and, immunologic factors adversely affect implantation of embryo. In recent years it has been shown that endometrial receptivity regulated by signaling molecules, prostaglandins, growth factors, cytokines, chemokine, leukemia integrin, and cadherin [3-6]
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