repeated ivf/icsi-ets failures and impact of hysteroscopy

Background: despite numerous developments in the field of assisted reproduction, theimplantation rate remains low. among the various reasons of implantation failure,endometrial regularity has an important role. hysteroscopy is an accurate method forevaluating the endometrial characteristics, with the ability to treat uterine pathology.objective: the aim of the present study was to evaluate the findings on hysteroscopyand thereafter the result of subsequent ivf/icsi in infertile women with the history offrequent unexplained and unsuccessful ivf/icsi attempts.materials and methods: in this observational study, the hysteroscopy findings and theoutcomes of subsequent ivf/icsi were evaluated in 89 infertile women admitted inavicenna infertility clinic, with previous repeated (more than two) failed ivf/icsiets,including the patients with normal hysterosalpinography (hsg) and excludingsevere male factor infertility and also thrombophilia, genetic and immunologicproblems. the data were analyzed with spss software and fisher exact, chi-square, andmc-nemar tests.results: in 53 (59.5%) cases, hysteroscopy revealed abnormal intrauterine findingsincluding adhesions 7 (13.7%), single polyp 11 (20.7%), endometrial polyposis 10(18.8%), endometrial hyperplasia 10 (18.8%), uterine cavity hypoplasia 4 (7.8%) andmyoma 5 (9.8%). these abnormalities were significantly higher in women with morethan 8 years of infertility (chi-square=4.7, p-value=0.03). after hysteroscopy andsubsequent ivf/icsi-et attempt using standard long protocol, pregnancy rate weresignificantly higher compared with the previous repeated ivf/icsi attempts (35.8%versus 0%).conclusion: according to this study, we strongly suggest evaluation of endometrialintegrity by hysteroscopy in patients with repeated ivf/icsi-ets failure, beforeentering any other fertilization procedures.