Effect of treatment of intrauterine pathologies with office hysteroscopy in patients with recurrent IVF failure

doi:10.1016/S1472-6483(10)61108-X

Reproductive BioMedicine Online

Volume 8, Issue 5, 2004, Pages 590-594

https://doi.org/10.1016/S1472-6483(10)61108-X Get rights and content

Abstract

The study was conducted to evaluate if the diagnosis and treatment of intrauterine lesions with office hysteroscopy is of value in improving the pregnancy outcome in patients with recurrent in-vitro fertilization and embryo transfer failure. Four hundred and twenty-one patients who had undergone two or more failed IVF-embryo transfer cycles were prospectively randomized into two groups. Group I (n = 211) did not have office hysteroscopic evaluation, Group II (n = 210) had office hysteroscopy. The patients who had normal hysteroscopic findings were included in Group IIa (n = 154) and patients who had abnormal hysteroscopic findings were included in Group IIb (n = 56). Intrauterine lesions diagnosed were operated during the office procedure. Fifty-six (26%) patients in Group II had intrauterine pathologies and the treatment was performed at the same time. No difference existed in the mean number of oocyte retrieved, fertilization rate, number of embryos transferred or first trimester abortion rates among the patients in groups. Clinical pregnancy rates in Group I, Group IIa and Group IIb were 21.6%, 32.5% and 30.4% respectively. There was a significant difference in the clinical pregnancy rates between patients in Group I and Group IIa (21.6% and 32.5%, P = 0.044, respectively) and Group I and Group IIb (21.6% and 30.4%, P = 0.044, respectively). There was no significant difference in the clinical pregnancy rate of patients in Groups IIa and IIb. Patients with normal hysterosalpingography but recurrent IVF-embryo transfer failure should be evaluated prior to commencing IVF-embryo transfer cycle to improve the clinical pregnancy rate.

Section snippets

Dr Aygul Demirol obtained her medical degree and further degree in the specialization of Obstetrics and Gynecology at Hacettepe University, School of Medicine, Ankara, Turkey. She is Clinical Director of the CLINIC Women Health, Infertility and IVF Center and she is currently working in the clinical and laboratory site of the IVF Unit. She is participating in research projects related to infertility and IVF.

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Cited by (182)

Effect of the decision to perform hysteroscopy on asymptomatic patients before undergoing assisted reproduction technologies—a systematic review and meta-analysis
2023, AJOG Global Reports
Routine hysteroscopic evaluation before assisted reproductive technology treatment is a novel approach with the potential to reduce assisted reproductive technology failure even in the absence of evidence of uterine pathology. Following the publication of several relatively high-quality trials on this topic, we sought to determine if this practice is beneficial.
We searched Web of Science, MEDLINE, PubMed, Scopus, Cochrane Library, and ClinicalTrials.gov from each database's inception until May 31, 2022 with our search strategy, attempting to locate all randomized controlled trials assessing the use of hysteroscopy in otherwise asymptomatic women undergoing assisted reproductive technology.
We included only randomized controlled trials that included at least one of our selected outcomes, and we excluded any studies with suspicion of pathology before the time of hysteroscopy, other than knowledge of the patient's infertility. We included all the aforementioned studies regardless of procedures or modifications performed as a result of hysteroscopic findings. Our initial search yielded 1802 results, which were reduced to 1421 after removal of duplicates. Ultimately, 11 studies were found to meet our criteria and were included in our quantitative synthesis.
We used ReviewManager software, version 5.4.1 to analyze the data, which we imported after manually gathering from the 11 studies. Continuous and dichotomous outcomes were imported as standard deviations. Pooled analysis was described as a mean difference, relative to 95 % confidence interval in cases of continuous data. Dichotomous outcomes were analyzed using risk ratios and 95% confidence intervals. In homogeneous outcomes, we used a fixed-effects model, and in heterogeneous outcomes we used a random-effects model.
Our results showed that hysteroscopy was associated with significant improvement in the clinical pregnancy rate (risk ratio, 1.27 [1.11–1.45]; P<.001). We found no differences between the hysteroscopy group and the control group in live birth rate (risk ratio, 1.26 [0.99–1.59]; P=.06), miscarriage rate (risk ratio, 0.99 [0.81–1.19]; P=.88), fertilization rate (risk ratio, 1.01 [0.93–1.09]; P=.88), incidence of multiple gestations (risk ratio, 1.29 [0.98–1.71]; P=.07), number of embryos transferred (mean difference, 0.04 [−0.18 to 0.26]; P=.73), chemical pregnancy rate (risk ratio, 1.01 [0.86–1.17]; P=.93), and number of oocytes retrieved (mean difference, 0.44 [−0.11 to 0.98]; P=.11).
We observed an improvement in the clinical pregnancy rate, but no significant improvement in the live birth rate with routine hysteroscopy before assisted reproductive technology treatment. We believe this does not represent sufficient evidence to recommend routine hysteroscopy for otherwise asymptomatic patients before assisted reproductive technology treatment at this time.
Modern assessment of the uterine cavity and fallopian tubes in the era of high-efficacy assisted reproductive technology
2022, Fertility and Sterility
The high efficacy of modern assisted reproductive technology (ART) and increase in the number of noninfertile patients who are using ART for family building in the United States call into question the relevance of the standard, one-size-fits-all infertility evaluation. Here, we explore whether all patients presenting for ART need uterine cavity and tubal assessment and what tests are most appropriate, efficient, and cost-effective in current times.
Hysteroscopic cervical features associated with difficult embryo transfer in unselected patients undergoing in vitro fertilization
2022, Biomedical Journal
The most appropriate diagnostic tests for the assessment of the uterine cavity in patients undergoing standard infertility evaluation in daily practice remain unclear. Routine hysteroscopic uterine cavity evaluation before an in vitro fertilization-embyo transfer (IVF-ET) cycle is not a uniformly accepted procedure. However, cervical findings associated with difficult ET have rarely been reported in previous hysteroscopic studies. The main objective of this study was to examine the relationship between cervical finding under flexible outpatient hysteroscopy (OH) and difficult ET.
A cohort clinical study was conducted with 650 patients undergoing their first in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) from January 2010 to December 2017. Of them, 605 women with available embryos underwent transfer cycles. Outpatient hysteroscopies were scheduled during the follicular phase of the menstrual cycle, 1–3 months before starting IVF/ICSI treatment.
Among the 650 women who underwent transvaginal sonography (TVS) and OH, abnormal sonographic findings were observed in 51 women (7.8%) in which submucous myoma, endometrial polyp, and endometrial hyperplasia were the most common. Abnormal hysteroscopic intracavitary findings were observed in 158 cases (24.3%) in which endometrial polyp, submucous myoma, and intrauterine adhesions were the most common. These results showed that TVS was specific (100%) but not sensitive (32.3%) compared with OH. Embryo transfer (ET) was difficult in 25% of women with cervical stenosis (CS) or tortuous cervical canal (TC) and was significantly more difficult in women in the TC group (30.7%) than in the CS group (19.6%).
OH can identify cervical charactistics associated with a high incidence of difficult ET.
Endometrial pathology and repeated implantation failures
2022, Immunology of Recurrent Pregnancy Loss and Implantation Failure: Volume 3
The process of implantation involves two main components: a competent embryo that should have the potential to implant and a receptive endometrium that should enable implantation. In this review, we focus on the role of the endometrium and its environment in the implantation process and related pathologies. We discuss endometrial pathologies that might contribute to the failure of implantation and discuss treatments and strategies that could potentially repair, correct, equilibrate an endometrium that is not receptive to embryo implantation.
Hysteroscopic endometrial peeling as a different approach to endometrial scratching. Case series report
2021, Journal of Gynecology Obstetrics and Human Reproduction
Citation Excerpt :
Earlier studies aiming to understand the effect of hysteroscopic endometrium biopsy on implantation have been methodologically diverse. Some report a significant correlation between the incidence of hysteroscopic biopsy and improved ART outcomes [10,12,13,21]. However, most of these only included fresh embryo transfer cycles and applied blind and nonspecific injuries to the endometrial cavity [10,21].
Does hysteroscopic endometrial peeling improve reproductive outcomes in women with implantation failure?
In this case series, 66 women underwent an hysteroscopic endometrial peeling and subsequently, a single frozen embryo transfer.
After the exclusion of patients with intraoperative incidental findings, pregnancy was achieved in 63% (42/66) of the women who underwent hysteroscopic endometrial peeling and subsequently a single frozen embryo transfer, clinical pregnancy rate was observed in 57% (38/66) of the patients and, clinical pregnancy loss occurred in 10% (4/38).
this novel surgical technique seems to increase implantation as well as clinical pregnancy rates in women with repeated implantation failure. We can hypothesize that the controlled and subtle degree of endometrial injury generated by the peeling generates an inflammatory cascade that enhances implantation.
Outpatient hysteroscopy impact on subsequent assisted reproductive technology: a systematic review and meta-analysis in patients with normal transvaginal sonography or hysterosalpingography images
2024, Reproductive Biology and Endocrinology

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Professor Timur Gurgan is the Head of the Division of Reproductive Endocrinology and Infertility, University of Hacettepe, Ankara, Turkey. He is the founder of the University IVF and Andrology Center which is the one of the most successful and academically well established centres in the Country. He trained in reproductive endocrinology, IVF and endoscopic surgery in UK, Canada, USA and Israel. His main interests are PCOS, endometriosis, assisted reproductive technology and reproductive surgery. He has over 100 national and international publications. He is acting as the Scientific Director of the Private CLINIC for Women Health, Infertility and IVF Unit in Ankara. He is also the President of 13th World Congress on IVF, Assisted Reproduction and Genetics, which will take place in 2005 in Istanbul.

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ArticleEffect of treatment of intrauterine pathologies with office hysteroscopy in patients with recurrent IVF failure

Abstract

Section snippets

Obstetrics and Gynecology Clinics of North America

Journal of the American Association of Gynecologic Laparoscopists

Fertility and Sterility

Fertility and Sterility

Journal of the American Association of Gynecology and Laparoscopy

Fertility and Sterility

Fertility and Sterility

Reproductive BioMedicine Online

Reproductive BioMedicine Online

Obstetrics and Gynecology

British Journal Obsetrics and Gynaecology

Fertility and Sterility

Fertility and Sterility

American Journal of Obstetrics and Gynecology

Obstetrics and Gynecology

Article
Effect of treatment of intrauterine pathologies with office hysteroscopy in patients with recurrent IVF failure