Recurrent implantation failures occur frequently during ART cycles in spite of the transfer of good quality embryos obtained from advanced embryo culturing techniques and embryo selection processes. Now, a recent study published in The Journal of Minimally Invasive Gynecology has provided more evidence about the potential of hysteroscopy in increasing the chances of conception in women with repeated implantation failures during IVF.
Evangelos Makrakis from the Embryo ART Unit, Athens, Greece and coworkers conducted the prospective study to determine the impact of hysteroscopy on subsequent conception in women with previous implantation failures following IVF. The observational study involved 1,475 patients with 2 consecutive unsuccessful implantations and on whom hysteroscopy was conducted, and 414 matched controls who either had or hadn’t undergone hysteroscopy. The researchers measured clinical pregnancy rate (CPR), ongoing pregnancy rate (OPR), and analyzed hysteroscopic findings.
Results showed 36.6% abnormal hysteroscopic and 22.2% unsuspected findings of all the study population. In comparison with the women with normal hysteroscopy results, those with abnormal findings demonstrated raised CPR and OPR in a new IVF cycle. A substantial increase in the CPR and OPR was also found in patients who had undergone hysteroscopy when compared to the controls. Also, hysteroscopy aided in detecting unsuspected abnormalities, which occurs more in women with a history of previous implantation failures post IVF. The scientists thus concluded that hysteroscopy in conjunction with appropriate therapy improves the odds of clinical and ongoing pregnancy in such women.
Earlier, Oliveira, et al. (Fertility and Sterility, 2003) conducted a prospective study to analyze the findings of hysteroscopy in 55 women with a history of repeated failed attempts to conceive following IVF-ET (embryo transfer). The patients included in the study were those who failed to conceive even after the transfer of atleast 2 good quality embryos in each attempt and whose hysterosalpingographic findings showed a normal uterine cavity prior to the initial IVF-ET cycle. Diagnostic and therapeutic hysteroscopy, along with standard transvaginal ultrasonography were the intervention methods used.
Abnormal endometrial results were found in 45% of the subjects who were subsequently treated by repairing the lesions. Following this, a third IVF-ET cycle was initiated in all the patients. The investigators showed that women treated for uterine pathologies, as opposed to those with normal uterine cavities on hysteroscopy, had greater pregnancy (50% vs. 20%) and implantation (19% vs. 5.5%) rates. Based on the study results, the scientists concluded that a higher incidence of abnormal findings on hysteroscopy is found in patients with recurrent unsuccessful attempts of IVF-ET. They also suggested that the use of hysteroscopy is beneficial in such cases to evaluate the endometrial integrity.
Since repeated implantation failure can occur due to various known and unknown factors, detecting every possible cause by currently available diagnostic tools is difficult. Hence, some studies have suggested adopting a different approach, such as repeated hysteroscopy and transfer of blastocysts, to enhance the pregnancy rates in such patients. With hysteroscopy identifying unsuspected pathologies in women who have had failed IVF cycles, the procedure, along with appropriate therapy, could be used as an effective strategy to improve the IVF outcomes.
References
1. Makrakis E, Hassiakos D, Stathis D, Vaxevanoglou T, Orfanoudaki E, Pantos K. Hysteroscopy in women with implantation failures after in vitro fertilization: findings and effect on subsequent pregnancy rates. J Minim Invasive Gynecol. 2009 Mar-Apr;16(2):181-7.
2. Oliveira FG, Abdelmassih VG, Diamond MP, Dozortsev D, Nagy ZP, Abdelmassih R. Uterine cavity findings and hysteroscopic interventions in patients undergoing in vitro fertilization-embryo transfer who repeatedly cannot conceive. Fertil Steril. 2003 Dec;80(6):1371-5.
