The Therapeutic Value of Hysteroscopic Assessment of Uterine Cavity in Cases of Implantation Failure in IVF Programs
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- Category: Vol. 78, March 2010
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The Therapeutic Value of Hysteroscopic Assessment of Uterine Cavity in Cases of Implantation Failure in IVF Programs, HOSSAM M. ALKADY
Abstract
Objective: To evaluate if the diagnosis and treatment of uterine abnormalities by hysteroscopy in patients undergoing IVF program is of any value in improving clinical pregnancy outcome.
Study Design: Prospective, randomized observational clinical trial.
Setting: Kuwait Maternity Hospital.
Subjects and Methods: A total of 100 patients with prior history of failed IVF cycles after transfer of good-quality embryos, were randomized in two groups. Group I (n=50) without hysteroscopy. Group II (n=50) had hysteroscopy and was sub classified into group IIa and group IIb. Group IIa (n=32) had normal hysteroscopic findings whereas Group IIb (n=18) had abnormal hysteroscopy findings which were corrected at the same time.
Intervention (s): Standard hysterosalpingography and diagnostic and therapeutic hysteroscopy.
Main Outcome Measure (s): Pregnancy and live birth rates after IVF cycles that followed diagnostic and therapeutic hysteroscopy.
Results: There was no difference in the mean number of oocytes retrieved, fertilization rate and number of embryos transferred among the patients in different groups. Statistically significant difference was observed in terms of clinical preg-nancy rates between group I and group IIa (24 and 40.6%, p<0.05), and group 1 and group 2b 24 and 38.8%, p<0.05), respectively.
Conclusion: Patient with recurrent IVF embryo transfer failure after normal hysterosalpingography findings should also be evaluated using hysteroscopy prior to further com-mencing IVF-embryo transfer cycles in order to enhance the clinical pregnancy rates. The incidence of pathologic findings on hysteroscopy is high in patients with repeated failures of IVF-ET. Evaluation of endometrial integrity by hysteroscopy is highly valuable and should be applied to all such cases.