Hysteroscopy in women with implantation failures after in vitro fertilization: findings and effect on subsequent pregnancy rates.

OBJECTIVE

To evaluate hysteroscopic findings and estimate the effect of hysteroscopy on achieving a pregnancy in women with a history of 2 implantation failures after in vitro fertilization (IVF).

DESIGN

Prospective observational and matched case control study.

DESIGN CLASSIFICATION

II-2.

SETTING

Private assisted reproduction units.

PATIENTS

A total of 1475 patients with a history of 2 consecutive implantation failures after IVF who had a hysteroscopy were studied; there were 414 matched pairs of women with a similar history who either had or did not have a hysteroscopy.

INTERVENTIONS

Hysteroscopy (diagnostic or operative), IVF/intracytoplasmic sperm injection cycle.

MEASUREMENTS AND MAIN RESULTS

Hysteroscopic findings, clinical pregnancy rate (CPR), and ongoing pregnancy rate (OPR) were measured. In all, 36.6% of the study population had abnormal hysteroscopic findings and 22.2% had unsuspected findings; women with abnormal hysteroscopic findings showed significantly increased CPR and increased OPR in a new IVF cycle compared with those with a normal hysteroscopy result. Women who had a hysteroscopy showed significantly increased CPR and OPR compared with matched control subjects who did not have the procedure. Hysteroscopy and appropriate therapy significantly increased the chances of achieving a subsequent clinical and ongoing pregnancy.

CONCLUSION

Women with 2 implantation failures after IVF had a remarkably high possibility for unsuspected abnormalities seen at hysteroscopy. Hysteroscopy could serve as a positive prognostic factor for achieving a subsequent pregnancy.