Hysteroscopy findings in recurrent in-vitro fertilisation failure

Abstract

Introduction. In vitro fertilization (IVF) has become a standard treatment for infertile couples. Increased success rates obtained over the years have resulted primarily from improved embryo quality, but implantation rates still remain lower than expected. The uterus, an important player in implantation, has been frequently neglected. While a number of uterine pathologies have been associated with spontaneous abortions, infertility and recurrent IVF failure.Aim of the study. To evaluate the role of hysteroscopic endometrial cavity evaluation and management prior to IVF in patients with repeated implantation failures.Materials and methods. We retrospectively studied 564 office hysteroscopies in patients with infertility and repeated IVF failure. Hysteroscopy was performed with a standard sequence, inspecting the endocervical canal, uterine cavity, endometrium, and tubal ostia. Findings were recorded using a standard report. Results. Normal hysteroscopic findings were reported in 388 women (68.7%). The other 176 (31.3%) were with abnormal hysteroscopy. The most common reported hysteroscopic abnormality was endometrial polyp 35,2% (62/176), followed by intrauterine adhesions 29,0% (51/176), chronic endometritis 25,0% (44/176), endometrial hyperplasia 5,6% (10/176) and Müllerian anomalies 5,1% (9/176). Conclusions. Patients with recurrent IVF embryo transfer failures should be reevaluated using hysteroscopy prior to initiating further IVF embryo transfer cycles in order to increase the clinical pregnancy outcome. Moreover, hysteroscopy should be considered as a crucial component for evaluation of infertile women with recurrent implantation failure.