Uterine Cavity Irrigation With Office Hysteroscopy During Ovarian Stimulation for IVF: A Randomized Controlled Trial.

Marzieh Ghasemi,Mahnaz Shahrakipour,Human M Fatemi,Faezeh Ghaemdoust,Ashraf Aleyasin

doi:10.3389/fendo.2022.778988

Abstract

ObjectiveThis was a non-blinded randomized controlled study to evaluate whether endometrial irrigation via office hysteroscopy during the early follicular phase would lead to a higher level of live birth rates compared to no irrigation in the fresh embryo transfer cycle.MethodThe study was conducted in Tehran university of medical sciences from June 2015 to June 2016. women under the age of 40 with primary infertility without history of previous IVF/ICSI or hysteroscopic examination, were included. Controlled ovarian hyperstimulation was done. Hysteroscopy was performed in the early mid-follicular phase of a stimulation cycle (day 5-7) with a vaginoscopy approach and saline irrigation in hysteroscopy group. Embryo-transfer was done in the same cycle.Results228 patients completed their participation in the study. In the fresh cycle, clinical pregnancy rate was 46% in the hysteroscopy group and 40.43% in the control group. (p-value= 0.326, RR= 1.16 [95%CI: 0.862 to 1.56]). Live birth rate was 41.28% in the hysteroscopic group and 31.93% in the control group (p-value=0.143, RR= 1.293 [95%CI: 0.916 to 1.825]). For those patients having surplus cryopreserved embryos, after 2 months, a second embryo transfer was performed. The cumulative LBR was 44.05% in the hysteroscopic group and 32.25% in the control group (p-value=0.029, RR= 1.368 [95%CI: 1.031 to 1.815], RD= 11.9% [95%CI: 1.2% to 22.3%] and NNT= 8 [95%CI: 4 to 85]).ConclusionThe current study clearly demonstrated a significantly higher cumulative live birth rate in the intervention group.Clinical Trial Registration[https://www.irct.ir/trial/19586], identifier IRCT2016011022795N2.

Highlights

Notwithstanding the many recent advances in the field of Assisted Reproductive Technology (ART), the chance of success is still very limited
228 patients completed their participation in the study
Among the papers and studies focusing on endometrial receptivity at the time of embryo transfer, Endometrial scratching in the cycle preceding IVF had been regarded as one of the most noteworthy methods that can affect the endometrial receptivity and probably improve the implantation rate [3]

Summary

Introduction

Notwithstanding the many recent advances in the field of ART, the chance of success is still very limited. For a pregnancy to occur, a receptive endometrium, a functional embryo at blastocyst developmental stage and synchrony between the embryo and the endometrium is required [2]. Failure to achieve receptivity and synchrony results in infertility and is a limiting factor for success in IVF treatment. Among the papers and studies focusing on endometrial receptivity at the time of embryo transfer, Endometrial scratching in the cycle preceding IVF had been regarded as one of the most noteworthy methods that can affect the endometrial receptivity and probably improve the implantation rate [3]. Because of manifold methods and different timings and anatomical locations of the injury caused, it is still not completely evident whether any manipulation at any specific time of the cycle can improve the implantation results [6]

Methods

Results

Conclusion