The therapeutic value of diagnostic saline hysteroscopy in cases of implantation failure in ivf programs

Abstract EN

Objective : to test the hypothesis that repeat IVF cycles (after a cycle with failed implantation of good quality embryos) are more likely to be successful] following saline hysteroscopy as compared to CO2 hysteroscopy, even in the absence of evident intra-uterine pathology Study Design : randomized controlled trial Setting: El-Doaa Hospital IVF Centre and Haya IVF Centre, Cairo, Egypt Subjects and Methods: 172 patients with prior history of failed IVF cycle(s) after transfer of good quality embryos, were randomized to have either saline hysteroscopy (group 1) or CO2 hysteroscopy (group 2) before commencing a new IVF cycle Main Outcome Measures : Pregnancy and live birth rates after the IVF cycle that followed diagnostic hysteroscopy Results : there was a statistically significant difference in the rate of chemical pregnancy in favor of the saline hysteroscopy group (group 1) as compared to the CO2 hysteroscopy group (group 2) (33 / 77 vs.

23 / 77, p = 0.013), as well as in clinical pregnancies diagnosed by transvaginal ultrasonography (30 / 77 vs.

21 / 77, p = 0.021).

The incidence of twin and triplet pregnancy was also higher in group 1 (6 sets of twins and 2 sets of triplets in group 1, vs.

4 sets of twins and 1 set of triplets in group 2).

Summing up these figures, it was found that 39 babies were born for group 1 patients out of 175 embryos transferred, compared to 25 babies out of 177 embryos transferred to group 2 patients (p = 0.002), which was highly statistically significant. Conclusion : We recommend the use of saline hysteroscopy rather than CO2 hysteroscopy to investigate the endometrial cavities of patients with implantation failure.

Besides its diagnostic value that has already been established, it probably has a therapeutic value as well.