title: Management of 273 cases of recurrent implantation failure: results of a combined evidence-based protocol.
abstract: This study evaluated the results of a management protocol combining a number of investigations and interventions, previously proven beneficial in randomized controlled trials in IVF/intracytoplasmic sperm injection (ICSI) patients with apparently unexplained recurrent implantation failure (defined as two or more previous failed cycles, during which at least six good-quality embryos were transferred). It was a prospective cohort study and included 273 couples with previous recurrent implantation failure. Each patient (all under 40) underwent a pre-treatment work-up, consisting of pelvic ultrasound scan for hydrosalpinx, hysteroscopy and screening for acquired and congenital thrombophilia. Detected abnormalities were dealt with accordingly: proximal occlusion for hydrosalpinx, hysteroscopic management for intrauterine pathology and thromboprophylaxis with daily low-molecular weight heparin from the day of embryo transfer for thrombophilia. The patients then underwent IVF/ICSI with laser-assisted hatching. 112 patients (41%; group 1) had abnormalities detected (17 hydrosalpinx, 11 intrauterine pathology, 63 congenital thrombophilia, 21 acquired thrombophilia) and the remaining 161 (59%; group 2) had normal work-up. The pregnancy rates per cycle started for all patients, group 1 and group 2 were 47%, 55% and 41%, respectively. This suggests that using the described management protocol in couples with previous recurrent implantation failure leads to a favourable chance of success.
authors.affiliation: Istishari Fertility Center, Istishari Hospital, PO Box 144733, Amman 11814, Jordan. k.sharif@mac.com
authors.forename: K W
authors.initials: KW
authors.lastname: Sharif
authors.forename: S
authors.initials: S
authors.lastname: Ghunaim
mesh_terms: D000328:Adult; D002985:Clinical Protocols; D010064:Embryo Implantation; D004624:Embryo Transfer; D019317:Evidence-Based Medicine; D005187:Fallopian Tubes / Q000473:pathology; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D015907:Hysteroscopy; D007246:Infertility / Q000209:etiology / Q000628:therapy*; D007621:Karyotyping; D008297:Male; D011247:Pregnancy; D012008:Recurrence; D027724:Reproductive Techniques, Assisted; D020554:Sperm Injections, Intracytoplasmic; D019851:Thrombophilia / Q000150:complications / Q000175:diagnosis; D017211:Treatment Failure