Usefulness of office hysteroscopy (oh) and endometrial biopsy in patients with recurrent implantation failure (rif)

Abstract

Objective. To define if office hysteroscopy (OH) and endometrial biopsy are useful tools in the evaluation of uterine cavity in recurrent implantation failure (RIF) patients and if they improve the pregnancy rate in subsequent IVF/ICSI cycles.
Material and methods. This is a cohort retrospective study. We performed OH in 84 RIF patients from July 2015 to June 2019. An endometrial biopsy was taken with a Pipelle cannula for anatomo-pathologic study.
Results. Four out of 84 OH were discontinued because of cervical stenosis. In the remaining 80 patients we found 53 normal cavities (66%) and 27 abnormal (34%): 7 sinequiae, 4 adenomyosis, 2 polyps and 14 chronic endometritis (CE) confirmed with the presence of plasmocytes in the endometrial biopsy. All patients with CE were treated with doxycycline (200mg daily for 14 days). We confirmed healing with a new biopsy in the next cycle. Only one patient had a complication (vaso-vagal syndrome). Pregnacy rates after OH were: 43% in normal cavities (23/53) and 52% in abnormal cavities (14/27). Pregnancy rates in patients with pathologic findings were: 28% in sinequiae (2/7), 25% in adenomyosis (1/4), 50% in polyps (1/2) and 71% in CE (10/14).
Conclusion. OH is a useful, safe and fast tool in trained hands and well tolerated in RIF patients, with good pregnancy rates in subsequent IVF/ICSI cycles. After OH and endometrial biopsy we obtained high pregnancy rates in patients with CE and antibiotic treatment and also in patients with normal hysteroscopic findings. Randomized controlled trials are needed before its routine use in general sub fertile or RIF patients can be recommended.