Effect of Hysteroscopic Surgery Before Frozen Embryo Transfer on Patients with Previous Implantation Failure

Abstract

Aim: The aim of this study was to evaluate the benefit of hysteroscopy (HS) before single frozen-thawed embryo transfer (sFET) on patients with previous implantation failure. Material and Methods: A total of 1352 infertile women with a previous implantation failure who underwent their first sFET treatment between January 2015 and December 2017 were included in this study. The patients were classified into two main groups in which HS was omitted (Group 1), and who underwent HS (Group 2). Furthermore, Group 2 was classified into two subgroups as patients without any intrauterine pathology (Group 2a), and those with intrauterine pathology (Group 2b). sFET was performed on all patients within 50 days of hysteroscopy. The major outcome measure was the clinical pregnancy rate. Results: The mean number of mature oocytes and fertilization rates were similar between groups. The clinical pregnancy rate was found to be 33.3% (n=70) in Group 1. Comparatively this rate was statistically significantly higher in patients in Group 2. The clinical pregnancy rate was 44.2% (n=378) in Group 2a, and 44.4% (n=127) in Group 2b (p=0.014). There was a significant difference between Group 1 and Group 2a (OR: 1.58, 95% CI: 1.15-2.17, p=0.004), and also Group 2b (OR: 1.59, 95% CI: 1.10-2.31, p=0.013). However, no significant difference was observed between Group 2a and Group 2b (p=0.896). Conclusion: Our findings demonstrate that HS surgery increases the probability of pregnancy rate at least by 1.58 times in patients having previous implantation failure when the hysteroscopic procedure is followed by sFET.

Keywords

• Hysteroscopy
• Infertility
• Blast
• sFET
• implantation failure

İmplantasyon Başarısızlığı Olan Hastalarda Donmuş Embriyo Transferi Öncesi Histeroskopik Cerrahinin Etkisi

Abstract

Amaç: Bu çalışmanın amacı, daha önce implantasyon başarısızlığı olan hastalarda tek donmuş çözülmüş embriyo transferi (single frozen-thawed embryo transfer, sFET) öncesi histeroskopinin faydasını değerlendirmektir. Gereç ve Yöntemler: Bu çalışmaya, Ocak 2015 ile Aralık 2017 tarihleri arasında daha önce bir implantasyon başarısızlığı olan ve ilk kez sFET tedavisi yapılan toplam 1352 infertil kadın dahil edildi. Hastalar HS yapılmayanlar (Grup 1) ve HS uygulananlar (Grup 2) olmak üzere iki ana gruba ayrıldı. Ayrıca, Grup 2, intrauterin patolojisi olmayan hastalar (Grup 2a) ve intrauterin patolojisi olanlar (Grup 2b) olmak üzere iki alt gruba ayrıldı. Tüm hastalara histeroskopi prosedüründen sonraki 50 gün içinde sFET uygulandı. Ana sonuç ölçütü klinik gebelik oranları idi. Bulgular: Ortalama olgun oosit sayısı ve fertilizasyon oranları gruplar arasında benzerdi. Grup 1’de klinik gebelik oranı %33,3 (n=70) olarak bulundu. Karşılaştırıldığında bu oran Grup 2’deki hastalarda istatistiksel olarak anlamlı şekilde daha yüksekti. Klinik gebelik oranı, Grup 2a’da %44,2 (n=378) ve Grup 2b’de ise %44,4 (n=127) idi (p=0,014). Grup 1 ile Grup 2a arasında (OR: 1,58; %95 GA: 1,15-2,17; p=0,004) ve aynı zamanda Grup 1 ile Grup 2b arasında (OR: 1,59; %95 GA: 1,10-2,31; p=0,013) istatistiksel olarak anlamlı fark vardı. Ancak Grup 2a ve Grup 2b arasında anlamlı bir fark gözlenmedi (p=0,896). Sonuç: Bulgularımız, histeroskopik prosedürü sFET ile takip edildiğinde, daha önce implantasyon başarısızlığı olan hastalarda HS cerrahisinin gebelik olasılığını en az 1,58 kat artırdığını göstermektedir.

Keywords

• İnfertilite
• Histeroskopi
• Blast
• sFET
• implantasyon başarısızlığı

References

1. Bashiri A, Halper KI, Orvieto R. Recurrent implantation failure-update overview on etiology, diagnosis, treatment and future directions. Reprod Biol Endocrinol. 2018;16(1):121.
2. Bouet PE, El Hachem H, Monceau E, Gariépy G, Kadoch IJ, Sylvestre C. Chronic endometritis in women with recurrent pregnancy loss and recurrent implantation failure: prevalence and role of office hysteroscopy and immunohistochemistry in diagnosis. Fertil Steril. 2016;105(1):106-10.
3. Margalioth EJ, Ben-Chetrit A, Gal M, Eldar-Geva T. Investigation and treatment of repeated implantation failure following IVF-ET. Hum Reprod. 2006;21(12):3036-43.
4. Hamilton JA, Larson AJ, Lower AM, Hasnain S, Grudzinskas JG. Routine use of saline hysterosonography in 500 consecutive, unselected, infertile women. Hum Reprod. 1998;13(9):2463-73.
5. Armstrong SC, Showell M, Stewart EA, Rebar RW, Vanderpoel S, Farquhar CM. Baseline anatomical assessment of the uterus and ovaries in infertile women: a systematic review of the evidence on which assessment methods are the safest and most effective in terms of improving fertility outcomes. Hum Reprod Update. 2017;23(5):533-47.
6. Makrakis E, Pantos K. The outcomes of hysteroscopy in women with implantation failures after in-vitro fertilization: findings and effect on subsequent pregnancy rates. Curr Opin Obstet Gynecol. 2010;22(4):339-43.
7. Raziel A, Schachter M, Strassburger D, Bern O, Ron-El R, Friedler S. Favorable influence of local injury to the endometrium in intracytoplasmic sperm injection patients with high-order implantation failure. Fertil Steril. 2007;87(1):198-201.
8. Narvekar SA, Gupta N, Shetty N, Kottur A, Srinivas M, Rao KA. Does local endometrial injury in the nontransfer cycle improve the IVF-ET outcome in the subsequent cycle in patients with previous unsuccessful IVF? A randomized controlled pilot study. J Hum Reprod Sci. 2010;3(1):15-9.

9. Karimzade MA, Oskouian H, Ahmadi S, Oskouian L. Local injury to the endometrium on the day of oocyte retrieval has a negative impact on implantation in assisted reproductive cycles: a randomized controlled trial. Arch Gynecol Obstet. 2010;281(3):499-503.
10. Kamath MS, Bosteels J, D'Hooghe TM, Seshadri S, Weyers S, Mol BWJ, et al. Screening hysteroscopy in subfertile women and women undergoing assisted reproduction. Cochrane Database Syst Rev. 2019;4(4):CD012856.
11. Cicinelli E, Matteo M, Tinelli R, Pinto V, Marinaccio M, Indraccolo U, et al. Chronic endometritis due to common bacteria is prevalent in women with recurrent miscarriage as confirmed by improved pregnancy outcome after antibiotic treatment. Reprod Sci. 2014;21(5):640-7.
12. Karayalcin R, Ozcan S, Moraloglu O, Ozyer S, Mollamahmutoglu L, Batıoglu S. Results of 2500 office-based diagnostic hysteroscopies before IVF. Reprod Biomed Online. 2010;20(5):689-93.
13. Fatemi HM, Kasius JC, Timmermans A, van Disseldorp J, Fauser BC, Devroey P, et al. Prevalence of unsuspected uterine cavity abnormalities diagnosed by office hysteroscopy prior to in vitro fertilization. Hum Reprod. 2010;25(8):1959-65.
14. Pabuçcu EG, Yalçın İ, Bodur T, Çağlar GS, Pabuçcu R. Impact of office hysteroscopy in repeated implantation failure: Experience of a single center. J Turk Ger Gynecol Assoc. 2016;17(4):197-200.
15. Smit JG, Kasius JC, Eijkemans MJC, Koks CAM, van Golde R, Nap AW, et al. Hysteroscopy before in-vitro fertilisation (inSIGHT): a multicentre, randomised controlled trial. Lancet. 2016;387(10038):2622-9.
16. El-Toukhy T, Campo R, Khalaf Y, Tabanelli C, Gianaroli L, Gordts SS, et al. Hysteroscopy in recurrent in-vitro fertilisation failure (TROPHY): a multicentre, randomised controlled trial. Lancet. 2016;387(10038):2614-21.
17. Pérez-Medina T, Bajo-Arenas J, Salazar F, Redondo T, Sanfrutos L, Alvarez P, et al. Endometrial polyps and their implication in the pregnancy rates of patients undergoing intrauterine insemination: a prospective, randomized study. Hum Reprod. 2005;20(6):1632-5.
18. Gürgan T, Kalem Z, Kalem MN, Ruso H, Benkhalifa M, Makrigiannakis A. Systematic and standardized hysteroscopic endometrial injury for treatment of recurrent implantation failure. Reprod Biomed Online. 2019;39(3):477-83.
19. Di Spiezio Sardo A, Di Carlo C, Minozzi S, Spinelli M, Pistotti V, Alviggi C, et al. Efficacy of hysteroscopy in improving reproductive outcomes of infertile couples: a systematic review and meta-analysis. Hum Reprod Update. 2016;22(4):479-96.
20. Takahashi K, Mukaida T, Tomiyama T, Oka C. High pregnancy rate after hysteroscopy with irrigation in uterine cavity prior to blastocyst transfer in patients who have failed to conceive after blastocyst transfer. Fertil Steril. 2000;74(3):S206.
21. Liu L, Li L, Ma X, Yue F, Wang Y, Wang L, et al. Altered circular RNA expression in patients with repeated implantation failure. Cell Physiol Biochem. 2017;44(1):303-13.
22. Nakamura A, Osonoi T, Terauchi Y. Relationship between urinary sodium excretion and pioglitazone-induced edema. J Diabetes Investig. 2010;1(5):208-11.
23. Potdar N, Gelbaya T, Nardo LG. Endometrial injury to overcome recurrent embryo implantation failure: a systematic review and meta-analysis. Reprod Biomed Online. 2012;25(6):561-71.
24. Nastri CO, Gibreel A, Raine-Fenning N, Maheshwari A, Ferriani RA, Bhattacharya S, et al. Endometrial injury in women undergoing assisted reproductive techniques. Cochrane Database Syst Rev. 2012;(7):CD009517.
25. Cicinelli E, Resta L, Nicoletti R, Tartagni M, Marinaccio M, Bulletti C, et al. Detection of chronic endometritis at fluid hysteroscopy. J Minim Invasive Gynecol. 2005;12(6):514-8.
26. Ben Abid H, Fekih M, Fathallah K, Chachia S, Bibi M, Khairi H. Office hysteroscopy before first in vitro fertilization. A randomized controlled trial. J Gynecol Obstet Hum Reprod. 2021;50(7):102109.
27. Eserol F, Göksever Çelik H, Aytan AN, Çelik A, Çelik E, Buyru F, et al. The effect of diagnostic hysteroscopy performed before fresh and frozen-thawed embryo transfer in IVF cycles on reproductive outcomes. J Turk Ger Gynecol Assoc. 2021;22(3):206-11.
28. Demirol A, Gurgan T. Effect of treatment of intrauterine pathologies with office hysteroscopy in patients with recurrent IVF failure. Reprod Biomed Online. 2004;8(5):590-4.
29. El-Toukhy T, Sunkara SK, Coomarasamy A, Grace J, Khalaf Y. Outpatient hysteroscopy and subsequent IVF cycle outcome: a systematic review and meta-analysis. Reprod Biomed Online. 2008;16(5):712-9.