Clinical utility of office hysteroscopy following failed in vitro fertilization–embryo transfer: A retrospective cohort study

Abstract

Objective

Despite its widespread use, in vitro fertilization (IVF) outcomes are challenged by implantation failure, largely due to factors such as embryo quality and endometrial receptivity. In this study, we investigated the clinical effect of office hysteroscopy (OH) on the subsequent frozen–thawed embryo transfer (FET) in infertile women who experienced a failed IVF–embryo transfer (IVF‐ET) cycle.

Methods

We included 577 infertile women who underwent OH because of a history of failed ET between October 2019 and September 2021. During OH, visible endometrial polyps (EPs) were diagnosed and removed by curette or biopsy forceps; chronic endometritis (CE) was diagnosed by histopathology and immunohistochemistry and treated with oral doxycycline (0.2 g/d) for 14 days. According to the hysteroscopic findings and endometrial pathology with immunohistochemistry, patients were divided into three groups: group A ( n = 161) had CE with or without EPs, group B ( n = 156) had EPs only, and group C ( n = 260) had no CE or EPs.

Results

In the following FET cycle, the implantation rates were 47%, 51%, and 45% ( P = 0.411); the clinical pregnancy rates were 56%, 62%, and 55% ( P = 0.436); the live birth rates were 45%, 51%, and 42% ( P = 0.205); and the miscarriage rates were 18%, 16%, and 22% ( P = 0.497) in groups A, B, and C, respectively. There were no significant differences among groups ( P > 0.05).

Conclusion

OH is helpful for diagnosis and treatment of abnormal intrauterine environment in women with a failed IVF cycle and further improves their pregnancy outcome in the following FET.

Synopsis

Before subsequent fertilization–embryo transfer, office hysteroscopy is helpful for improving pregnancy outcome in women with failed in vitro fertilization.