The outcomes of hysteroscopy in women with implantation failures after in-vitro fertilization: findings and effect on subsequent pregnancy rates

Abstract

To update information on the findings of hysteroscopy in women with implantation failures after in-vitro fertilization (IVF) as well as on the effect of the procedure on subsequent pregnancy rates. Information from three review publications indicates that the incidence of abnormal hysteroscopic findings in women with repeated implantation failures (RIFs) varies between 25 and 50%, whereas by pooling data from randomized studies, hysteroscopy significantly increases the clinical pregnancy rate (CPR) on the subsequent IVF cycle (pooled RR = 1.57, 95% CI: 1.29-1.92, P < 0.00001). Two recent clinical articles reported that the incidence of abnormal hysteroscopic findings in RIF patients was approximately 37%: the one study reported no differences in CPR between RIF patients with abnormal versus normal hysteroscopy; the second study reported significantly increased CPR in RIF patients with abnormal or treated hysteroscopic findings compared to those with a normal hysteroscopy, as well as in RIF patients having a hysteroscopy compared to controls not having the procedure. There is accumulated evidence that hysteroscopy is beneficial for women experiencing implantation failures after IVF. Not only the correction of hysteroscopic findings improves the pregnancy rates, at least when compared to controls not having a hysteroscopy, but also the procedure itself may have a positive prognostic value for achieving a subsequent pregnancy.