Office hysteroscopy in cases of recurrent implantation failure; Do or not to do

Abstract

Objective: To assess the management and outcome of office hysteroscopy in patients experiencing recurrent implantation failure (RIF) with two or more intra cytoplasmic sperm injection (ICSI) failures. Study design: The prospective study was conducted at Elshatby maternity university hospital and Misrata National Center for Infertility, Misrata, Libya. One hundred and seventy-five female patients aged below 40 years and with 2 or more previous ICSI failures, with 2 fresh embryos transferred per attempt were included in the study. Office hysteroscopy was done in all patients to assess the endometrial cavity for any abnormal uterine findings and clinical pregnancy rate after hysteroscopy was evaluated. At the end of hysteroscopy, endometrial biopsy was done to observe prevalence of any different inflammatory cells, plasma cells or lymphocytes. Results: Out of 175 patients, 135 had abnormal hysteroscopic findings with single and combined pathologies. Endometritis 43 (65%) and septum with endometritis 34 (49%) were the most common pathologies observed. After office hysteroscopy, 13 (19.6%) women with single pathology and 13 (18.8%) women with combined pathologies became pregnant. Of the 175 patients studied, pregnancies occurred in 33 (18.8%) women with two or more ICSI failures after corrected endometrial pathology by hysteroscopy. Conclusion: Office hysteroscopy is a good diagnostic and therapeutic tool in cases of recurrent implantation failure. It has the potential to improve pregnancy rate in these patients.