Abstract:

Objective To investigate the clinical significance of hysteroscopy after repeated implantation failure (RIF) in in vitro fertilization and embryo transfer (IVF-ET). Methods The hysteroscopic results of 197 women with failure in IVF-ET for no less than two times (RIF group) and 176 women undergoing artificial insemination with donor semen (control group) were retrospectively analysed, and the incidences and types of abnormal hysteroscopic findings were compared between two groups. Results The incidence of abnormal hysteroscopic findings in RIF group was significantly higher than that in control group (51.78% vs 28.98%, P<0.01), and the types of abnormal hysteroscopic findings in RIF group were more than those in control group. The main types of abnormal hysteroscopic findings in RIF group were endometrial abnormalities (polypi and polypoid proliferation, 26.39%; endometritis, 4.06%) and abnormal shape of uterine cavity (uterine cavity narrowness, 9.64%; uterine cavity adhesion, 5.08%). The incidence of uterine cavity abnormalities of each age group in RIF group was higher than that in control group, especially for the age groups of 25 to 29 years and 30 to 34 years (P<0.01, P<0.05). Logistic regression analysis revealed that types of RIF (P=0.001, OR=2.320, 95%CI：1.440-3.736) and age (P=0.039, OR=1.403, 95%CI：1.016-1.935) were risk factors of uterine cavity abnormalities, while duration of infertility (P=0.747，OR=1.038，95%CI：0.827-1.303) was not risk factor of uterine cavity abnormalities. In women with RIF, there was no significant difference in the incidence of uterine cavity abnormalities between primary infertility group and secondary infertility group （P>0.05）, while the incidence of polypi and polypoid proliferation in primary infertility group was significantly higher than that in secondary infertility group （31.45% vs 17.80%，P<0.05）, and the incidence of uterine cavity adhesion in primary infertility group was significantly lower than that in secondary infertility group (2.42% vs 9.59%，P<0.05). Conclusion The incidence of uterine cavity abnormalities in women with RIF is significantly higher than that in normal women, and the main types of uterine cavity abnormalities are polypi and polypoid proliferation. Hysteroscopic examiation should be carried out in women with RIF to improve the environment of uterine cavity and endometrium receptivity. Women with RIF are advised to undergo hysteroscopy before receiving a second ET.

Key words: hysteroscopy, repeated implantation failure, artificial insemination by donor semen, abnormal uterine cavity, endometrial receptivity