Role of hysteroscopy in patients with recurrent implantation failure (RIF)‎

الملخص EN

Background : implantation failure after embryo transfer is one of the main problems of in vitro fertilization, (IVF), intrauterine pathologies can lead to unsuccessful outcome.

Margalioth EJ, et al., (2006) Hysterosailpingography, transvaginal ultrasonography, saline infusion sonography and hysteroscopy are the tools to assess the inner architectur of the uterus.

Hysteroscopy is considered to be the gold standard for diagnosis of intrauterine lesion.

Golan A, et al., (1996).

Systematic hysteroscopy before IVF is widely accepted practice that is supposed to improve pregnancy rates but still lacks scientific evidence.

After repeated implantation failure in IVF cycles, uterine cavity could be reevaluated by hysterocopy and this practice has been demonstrated to improve pregnancy rates.

Flavio G Olivera, Vol.

80, No.6.

Objectives: The aim of this study was to determine role of hysteroscopic examination of uterine cavity in patients with failed one or more I.V.F.

cycles.

Bettochi S, et al., (2004).

Methodology: This is a prospective, observational study was carried out in Women’s Hospital, Hamad Medical Corporation, Doha, Qatar, involving 130 consecutive infertile patients for whom two or more failed IVF cycles despite of transfer good quality embryo(s).

This study was carried out in the period from April 2009 to June 2011.

Results: 130 patients underwent hysteroscopy.

In all cases hysteroscopic visualization of the uterine cavity, vas adequate.

The mean age was 27.12 + 4.51 years, the mean duration of marriage 6.67 + 3.42 years, 69.2 % of women involved in the study had a single failed trial, while 23.1 % had previous two failed trials, and 7.7 % had previous three failed trials, 33patients 25.4 % had positive data as following 10.8 % had uterine and cervidal polyp, 6.2 % had congenital anomalies, 3.8% had intrauterine adhesion, 2.3 % had sub mucous myoma, 1.5 % had endometritis while 0.8 % had endometrial hyperplasia.

These abnormalities were believed to be causal factor in the failure of IVF.

79 % of the cases had no intervention (only diagnostic hysteroscopy), while 21 % of the cases had operative interventions in the form of adhesiolysis 4 %, poil, pectomy in II % and resection of septum in 4 %.

Conclusions : hysteroscopy is considered to be the gold standard not only to diagnose but also to treat many kinds of benign intrauterine pathology.

The frequency of unsuspected intrauterine pathologies discovered by hysteroscopy in patients with Recurrent Implantation Failure ranges from 18-50 %.

In patients with RIF, pregnancy rates appear to be improved in patients with normal hysteroscopy or corrected pathology.