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Get Help Now!Purpose Endometrial scratching (ES) using a biopsy catheter prior to the IVF cycle in the repeated implantation failure (RIF) population has been suggested, but no convincing evidence of its beneft has been presented until now. Methods A retrospective mono-center study among 300 consecutive IVF-RIF cycles following evaluation of the ovarian reserve, hysterosalpingography or hysteroscopy, pelvic ultrasound, thrombophilia evaluation, karyotyping and assessment of male sperm parametrs. The fndings within normal limits. All the patients ofered ES, 78 consented and underwent ES prior to their next IVF cycle. Results A comparison of treatment outcomes between the post-ES cycles (n=78) and the non-ES cycles (222) demonstrated the following: 34 (43.5%) versus 14 (6.3%) conceptions, respectively (p=0.001) and 30 (38.4%) versus 2 (0.9%) clinical pregnancies, respectively (p<0.001%), emphasizing an extremely high biochemical pregnancy rate among the non-ES cycles. Implantation rate was 19.7% versus 0.4%, respectively (p<0.001) and live birth rate was 33.33% (26 newborns) versus 0.45% (1 newborn), respectively (p<0.001). Since there were more embryos available for transfer and more top-quality embryos in the post-ES–IVF conception cycles, the role of ES became questionable. A multivariate analysis that included ES and the percentage of top-quality embryos demonstrated that ES was an independent factor highly correlated with conception in this particular RIF population. Conclusions ES proved to be an efcient tool in a particular subgroup of RIF patients with fertility investigation results within normal limits, an optimal ovarian response to gonadotropins, and a high percentage of top-quality embryos. Nevertheless, the results should not be overestimated, since the study has limitations related to its retrospective model.
Keywords IVF · Recurrent implantation failure (RIF) · Ovarian reserve · Conception rates · Endometrial scratching
Introduction
Although IVF treatment outcomes have advanced dramatically in terms of conception, implantation, and live birth rates, cycles with unexplained repeated implantation failures (RIF) remain an unsolved and extremely challenging issue [1]. The characterization of RIF remains vague. It has been defned in various ways in the literature, from failure to achieve embryo implantation after 2–6 IVF cycles in which approximately ten embryos are transferred [2] to more the recently proposed defnition of two or more failed cycles and at least four cleavage-stage embryos transferred with no conception achieved [3]
Repeated implantation failure can be attributed to any of the key players: the gamete, the embryo, the endometrium, or any combination of factors. Among the deleterious factors that cause RIF, abnormal karyotype is a possibility and karyotyping is suggested as part of RIF workup [4]. Recent studies suggest that testing blastocyst-stage embryos in patients with RIF capable of producing blastocysts may improve conception rates [5].
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