title: Hysteroscopy in patients with repeated implantation failure improves the outcome of assisted reproductive technology in fresh and frozen cycles.
abstract: OBJECTIVE
  Repeated implantation failure (RIF) is still a problem for many patients and their physicians. Some interventions have been practiced to overcome the problem; one is uterine cavity assessment before assisted reproductive technology (ART) cycles. This study aimed to evaluate the effect of hysteroscopy in women experiencing recurrent implantation failure with apparently normal uterine cavity before assisted reproductive techniques.
  
  
  METHODS
  This was a cohort study with historical controls conducted in a university hospital. A total of 353 women with RIF undergoing ART with normal hysterosalpingography and transvaginal ultrasound were evaluated. The intervention group underwent hysteroscopy with a rigid, 30°, 4-mm hysteroscope in the menstrual cycle just before ART; in the control group hysteroscopy was not performed. Basal characteristics, stimulation parameters and pregnancy rates were compared between the two groups.
  
  
  RESULTS
  Chemical pregnancy occurred in 58.5% of women in the hysteroscopy group versus 34.1% of control women (odds ratio [OR]: 2.7; 95% confidence interval [CI]: 1.7-4.2; P < 0.001). Clinical pregnancy occurred in 50.7% and 30.3% of women in the hysteroscopy and control groups, respectively (OR: 2.4; 95%CI: 1.5-3.7; P < 0.001). Delivery rate was 35.5% in hysteroscopy women and 21.1% in control women (OR: 1.9; 95%CI: 1.2-3.1; P = 0.008). The results of hysteroscopy were normal in 103 women (72.5%), and they revealed inflammation in 22 (15.5%), polyp in 16 (11.3%) and Asherman syndrome in one patient (0.7%).
  
  
  CONCLUSIONS
  Hysteroscopy in the menstrual cycle before ovarian stimulation in fresh cycles and before endometrial preparation in frozen thawed cycles in women experiencing recurrent implantation failure with apparently normal uterine cavity significantly increases the pregnancy rates in fresh and frozen cycles, respectively.
authors.affiliation: Department of Infertility, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Marzieh Agha
authors.initials: MA
authors.lastname: Hosseini
authors.forename: Nasim
authors.initials: N
authors.lastname: Ebrahimi
authors.forename: Atossa
authors.initials: A
authors.lastname: Mahdavi
authors.forename: Ashraf
authors.initials: A
authors.lastname: Aleyasin
authors.forename: Leili
authors.initials: L
authors.lastname: Safdarian
authors.forename: Parvin
authors.initials: P
authors.lastname: Fallahi
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Esfahani
mesh_terms: D000328:Adult; D015331:Cohort Studies; D010064:Embryo Implantation; D005260:Female; D005615:Freezing; D006801:Humans; D015907:Hysteroscopy; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies; D027724:Reproductive Techniques, Assisted
keywords: assisted reproductive technology; fresh; hysteroscopy; implantation failure; pregnancy