title: Endometrial injury, the quality of embryos, and blastocyst transfer are the most important prognostic factors for in vitro fertilization success after previous repeated unsuccessful attempts.
abstract: OBJECTIVE
  The purpose of this study was to find out the most important prognostic factors for achieving a pregnancy after in vitro fertilization (IVF) in women with history of repeated unsuccessful IVF attempts.
  
  
  METHODS
  We analyzed factors affecting pregnancy rate in a retrospective study including 429 IVF/ICSI cycles performed in women younger than 40 years with at least three previous consecutive failed IVF/ICSI attempts.
  
  
  RESULTS
  Clinical pregnancy was observed in 140/429 (32.6%) cycles. Clinical pregnancy rate (CPR) was significantly higher in cycles with LEI compared to cycles without LEI before embryo transfer (44.4 vs 26.54%, p = 0.007). The CPR was also higher in cycles with day 5 blastocyst- compared with day 3 cleavage-stage embryo transfers (45.51 vs 26.54%, p < 0.001). In multivariate logistic regression model, only transfer of at least one good quality embryo (OR = 4.32, 95% CI 2.41-7.73), local endometrial injury (OR = 1.73, 95% CI 1.02-2.92), and transfer on day 5 (OR = 3.02, 95% CI 1.53-5.94) remained important independent prognostic factors for clinical pregnancy.
  
  
  CONCLUSIONS
  These results suggest that hysteroscopy with local injury to the endometrium prior to ovarian stimulation for IVF/ICSI can improve implantation and pregnancy rates in women experiencing recurrent IVF failure. However, large studies are needed to confirm these findings.
authors.affiliation: Department of Reproductive Medicine and Gynecologic Endocrinology, Clinic for Gynecology and Perinatology, University Medical Centre Maribor, Ljubljanska 5, 2000, Maribor, Slovenia. milan.reljic@ukc-mb.si.
authors.forename: Milan
authors.initials: M
authors.lastname: Reljič
authors.affiliation: Department of Reproductive Medicine and Gynecologic Endocrinology, Clinic for Gynecology and Perinatology, University Medical Centre Maribor, Ljubljanska 5, 2000, Maribor, Slovenia.
authors.forename: Jure
authors.initials: J
authors.lastname: Knez
authors.affiliation: Department of Reproductive Medicine and Gynecologic Endocrinology, Clinic for Gynecology and Perinatology, University Medical Centre Maribor, Ljubljanska 5, 2000, Maribor, Slovenia.
authors.forename: Vilma
authors.initials: V
authors.lastname: Kovač
authors.affiliation: Department of Reproductive Medicine and Gynecologic Endocrinology, Clinic for Gynecology and Perinatology, University Medical Centre Maribor, Ljubljanska 5, 2000, Maribor, Slovenia.
authors.forename: Borut
authors.initials: B
authors.lastname: Kovačič
mesh_terms: D000328:Adult; D001755:Blastocyst / Q000378:metabolism / Q000473:pathology; D010064:Embryo Implantation / Q000502:physiology*; D004624:Embryo Transfer; D004717:Endometrium / Q000293:injuries* / Q000503:physiopathology; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D011247:Pregnancy; D018873:Pregnancy Rate; D011379:Prognosis; D020554:Sperm Injections, Intracytoplasmic
keywords: Blastocyst transfer; Local endometrial injury; Recurrent IVF failure