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

Abstract

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...

The Effect of Hysteroscopy on the Reproductive Outcomes of Infertile Women Without Intrauterine Pathologies: A Systematic Review and Meta-Analysis

“…After the full text review, 111 studies were excluded and 9 studies were included, and 2 studies were included by hand search (March 10, 2020). Ultimately, a total of 11 studies were included [23,[32][33][34][35][36][37][38][39][40][41]. The basic characteristics of the included studies are shown in Table 1.…”

“…Six and 5 randomized and non-randomized controlled trials [32,33,35,37,39,40], [23,34,36,38,41], respectively, were selected that investigated the CPRs or LBRs in infertile women without intrauterine lesions after hysteroscopy. Of the 11 studies that were included, 4 (36.4%) were conducted in Turkey [32,36,38,41] and 2 (18.2%) in Iran [23,40], while others were conducted in Egypt [35], Greece [34], India [33], the Netherlands [39], and Europe (n=1 for all) [37]. All of the subjects included in the studies were diagnosed with infertility and planning to use ART (IVF/ICSI).…”

“…A 2.9-5.5 mm diameter hysteroscope was used for the intervention group. Four and 3 cases (36.4% and 27.3%, respectively) used a 4 mm and 5 mm diameter hysteroscope, respectively [23,32,33,36,[38][39][40]. One study (15.4%) did not mention the diameter of the hysteroscope used [41].…”

“…Of the 5 non-randomized studies, 4 [23,34,38,41] were classified as "moderate risk" for bias due to confounding (the pre-intervention domain in confounding) because the confounding variables were properly measured and controlled, and the measurement of the important domains was sufficiently reliable and valid. In 1 study [36], even though IVF was performed, the confounding variables for whether the patients experienced RIF were not identified, therefore it was graded as "serious risk".…”

“…birth is only about 34% (43%, 35.8%, and 24.9% in patients who are [35][36][37][38][39][40], and 41-42 years old, respectively) [6].…”