Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences of Yazd
Abstract
Background: Despite numerous developments in the field of assisted
reproduction, the implantation rate remains low. Among the various
reasons of implantation failure, endometrial regularity has an
important role. Hysteroscopy is an accurate method for evaluating the
endometrial characteristics, with the ability to treat uterine
pathology. Objective: The aim of the present study was to evaluate
the findings on hysteroscopy and thereafter the result of subsequent
IVF/ICSI in infertile women with the history of frequent unexplained
and unsuccessful IVF/ICSI attempts. Materials and Methods: In this
observational study, the hysteroscopy findings and the outcomes of
subsequent IVF/ICSI were evaluated in 89 infertile women admitted in
Avicenna Infertility Clinic, with previous repeated (more than two)
failed IVF/ICSIETs, including the patients with normal
Hysterosalpinography (HSG) and excluding severe male factor infertility
and also thrombophilia, genetic and immunologic problems. The data were
analyzed with SPSS software and Fisher exact, chi-square, and MC-Nemar
tests. Results: In 53 (59.5%) cases, hysteroscopy revealed abnormal
intrauterine findings including adhesions 7 (13.7%), single polyp 11
(20.7%), endometrial polyposis 10 (18.8%), endometrial hyperplasia 10
(18.8%), uterine cavity hypoplasia 4 (7.8%) and myoma 5 (9.8%). These
abnormalities were significantly higher in women with more than 8 years
of infertility (chi-square=4.7, p-value=0.03). After hysteroscopy and
subsequent IVF/ICSI-ET attempt using standard long protocol, pregnancy
rate were significantly higher compared with the previous repeated
IVF/ICSI attempts (35.8% versus 0%). Conclusion: According to this
study, we strongly suggest evaluation of endometrial integrity by
hysteroscopy in patients with repeated IVF/ICSI-ETs failure, before
entering any other fertilization procedures
