Hysteroscopy in recurrent in-vitro fertilisation failure (TROPHY): a multicentre, randomised controlled trial

El‐Toukhy, Tarek; Campo, Rudi; Khalaf, Yacoub; Tabanelli, Carla; Gianaroli, Luca; Gordts, S.; Gordts, Stephen; Mestdagh, G; Mardešić, T; Voboril, J; Marchino, Gian Luigi; Benedetto, Chiara; Al-Shawaf, Talha; Sabatini, Luca; Seed, Paul; Gergolet, Marco; Grimbizis, Grigoris; Harb, Hoda; Coomarasamy, Aravinthan

doi:10.1016/s0140-6736(16)00258-0

Cited by 168 publications

(140 citation statements)

References 28 publications

(36 reference statements)

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“…The same favorable results have been reported when oHS was performed within 50 days (13) or even within 6 months prior to a new ART (16). On the other hand, this impact is somehow questionable in light of the recent conflicting evidence (5,26). Further research is still needed to optimize instrumentation and timing.…”

Section: Discussionmentioning

confidence: 88%

“…Despite several advantages, the European Society of Human Reproduction and Endocrinology does not recommend routine oHS in women undergoing ART, unless there is an apparent uterine pathology (4). Moreover, two recent randomized controlled trials have failed to show any clear benefit of this procedure either before the first IVF cycle or in repeated failed cycles (5,6). The present study aimed to evaluate the incidence of unrecognized uterine pathologies with oHS in women with RIF as well as the impact of oHS on live birth rates (LBRs) when performed prior to a new ART cycle.…”

Section: Introductionmentioning

confidence: 98%

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Impact of office hysteroscopy in repeated implantation failure: Experience of a single center

Pabuçcu¹,

Yalçın²,

Bodur³

et al. 2016

J Turkish German Gynecol Assoc

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Objective: Repeated implantation failure (RIF) is a clinical entity affecting many couples undergoing assisted reproductive technology (ART).Various intrauterine pathologies contribute to RIF. Nevertheless, vaginal sonography and hysterosalpingography, which are the common diagnostic tools for the initial follow-up, have limited sensitivities. In this context, we aimed to evaluate the impact of office hysteroscopy (oHS) on live birth rates (LBRs) when performed prior to subsequent ART cycles in women with a history of RIF. Material and Methods:The database of an assisted reproduction center was retrospectively reviewed to detect eligible cases. A total of 363 women out of 2875 admissions were consecutively included in the analysis, of which 119 formed the oHS group and 244 formed the non-oHS group prior to a new ART cycle. Women in the oHS arm were examined during their early follicular phase via a vaginoscopic approach 1-6 months before the beginning of a new cycle. The standard in-vitro fertilization-intracytoplasmic sperm injection (IVF/ICSI) cycle was applied to all the women. Results:In the oHS group (n=119), 61 patients had intrauterine abnormalities, with an overall abnormality rate of 51.2%. Implantation, pregnancy, and LBRs of the groups were statistically similar. LBRs of the women with abnormal oHS findings (15/61, 24.5%), with normal oHS findings (14/58, 24.1%), and without oHS (39/244, 16%) were statistically similar (p=0.41). Conclusion:Unrecognized intrauterine pathologies can be easily detected and concurrently treated during oHS with high success rate. However, a beneficial impact depends on the extent of the pathology and thus, routine application to enhance reproductive outcomes is still not warranted. (J Turk Ger Gynecol Assoc 2016; 17: 197-200) Keywords: Endometrium, in-vitro AbstractSubjects who underwent the procedure formed the oHS group, whereas the remaining subjects formed the non-oHS group. All included patients were between 18 and 40 years of age and had follicle-stimulating hormone (FSH) levels of <15 IU/mL. The exclusion critertia were 1) poor ovarian response according to the Bologna criteria (8) or women with premature ovarian failure; 2) male subjects with severe oligozoospermia, oligoasthenozoospermia, or azoospermia; 3) preimplantation genetic screening and cryopreserved/thawed embryo transfer cycles; 4) women with confirmed endometriosis; 5) women with hypothalamic amenorrhea; and 6) women who underwent oHS more than 6 months prior to a new cycle.Office hysteroscopy procedure All patients were examined during their early follicular phase, 1-6 months before the start of a new ART cycle, via the vaginoscopic approach as previously described (9). No routine preoperative analgesia, antibiotics, sedation, or cervical preparation was used. Briefly, a rigid hysteroscope (continuous flow; 30° forward oblique view) with an outer diameter of 4 mm using 0.9% normal saline was used. Following adequate distension of the uterine cavity, systematic inspection was performed. Standard g...

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Section: Discussionmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 98%

Impact of office hysteroscopy in repeated implantation failure: Experience of a single center

Pabuçcu¹,

Yalçın²,

Bodur³

et al. 2016

J Turkish German Gynecol Assoc

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“…Randomized, controlled studies have indicated that blastocyst transfer and salpingectomy may improve clinical outcomes in couples with RIF (2). Hysteroscopy in the preceding cycle has been reported to improve pregnancy outcomes in couples with three or more failed ET cycles (6), but this evidence has recently been contradicted by a multicenter, randomized controlled trial that showed hysteroscopy to be of no value in RIF (7). Furthermore, other techniques such as assisted hatching are still considered controversial in RIF patients (8), and the same debates continue with zygote intrafallopian transfer, cocultures, and preimplantation genetic screening (2,3,9).…”

mentioning

confidence: 99%

Revisiting the management of recurrent implantation failure through freeze-all policy

Magdi

El-Damen²,

Fathi

et al. 2017

Fertility and Sterility

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“…[23][24][25] The results of these studies suggest that there is no reason to perform hysteroscopy before IVF, irrespective of whether the woman is about to undergo the first cycle of IVF or if she has undergone several failed IVF attempts, as long as conventional transvaginal ultrasound shows no uterine pathology. These studies did not find an answer on the significance of hysterescopic correction of the common intrauterine lesions as polyps, submucous myomata or partial septae prior to IVF/ICSI and their relation to pregnancy rates.…”

mentioning

confidence: 99%

Competing Endoscopic Surgeries in the Era of Assisted Reproductive Technologies: Evidence and Practice

Dawood¹,

Omar²

2017

Gynecol Obstet Res Open J

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Hysteroscopy in recurrent in-vitro fertilisation failure (TROPHY): a multicentre, randomised controlled trial

Abstract: European Society of Human Reproduction and Embryology, European Society for Gynaecological Endoscopy.

Cited by 168 publications

References 28 publications

Impact of office hysteroscopy in repeated implantation failure: Experience of a single center

Impact of office hysteroscopy in repeated implantation failure: Experience of a single center

Revisiting the management of recurrent implantation failure through freeze-all policy

Competing Endoscopic Surgeries in the Era of Assisted Reproductive Technologies: Evidence and Practice

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