Unit:
Faculty of MedicineLibrary of the School of Health Sciences
Dissertation committee:
Νικόλαος Παπαντωνίου, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Νικόλαος Βλάχος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Κωνσταντίνος Νταφόπουλος, Καθηγητής, Ιατρική Σχολή, Πανεπιστήμιο Θεσσαλίας
Χαράλαμπος Συριστατίδης, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Χαράλαμπος Χρέλιας, Αναπληρωτής καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Μακάριος Ελευθεριάδης, Αναπληρωτής καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Μαρία Σιμοπούλου, Αναπληρώτρια καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Η επίδραση του τραυματισμού ενδομητρίου πριν από κατεψυγμένο κύκλο σε γυναίκες με ιστορικό επανειλημμένων αποτυχιών εμφύτευσης
Translated title:
Τhe effect of endometrial injury before a frozen cycle on women with repeated implantation failures
Summary:
Introduction: The use of assisted reproduction techniques during the last decades, led to an increase in clinical pregnancy rates (CPR) and live birth rate (LBR), thus becoming today the final and most modern option to treat an infertile couple. Yet success rates of IVF, particularly the LBR, still remains low and does not exceed 35%. Therefore, the implantation failure has been the subject of numerous clinical studies in the recent years that aim at both the clarification of this phenomenon, and the search for solutions that will increase the endometrial receptivity. Recently data from RCTs and meta-analyses suggest that the transfer of frozen embryo achieves equal or higher LBR and CPR. Therefore, the strategy of freezing all embryos and the transfer of frozen embryos in the next cycle has been established as a standard practice. One more promising method to increase the endometrial receptivity especially in women with repeated implantation failures is that of endometrial injury. This technique is applied during the cycle before the embryo transfer and comprises endometrial injury with a view to activation of humoral and immune mechanisms leading to increased endometrial receptivity during the subsequent embryo transfer. Through a non-randomized clinical trial we evaluated the effect of the combination of hysteroscopic endometrial injury and freeze-all technique on pregnancy parameters in a cohort of RIF patients.
Objective: Through a non-randomized clinical trial we evaluated the effect of the combination of hysteroscopic endometrial injury and freeze-all technique on pregnancy parameters in a cohort of RIF patients.
Participants and Methods: This two-center two-arm non-randomized clinical study was conducted at the Assisted Reproductive Units of the Third Department of Obstetrics and Gynecology, “Attikon” Hospital, National and Kapodistrian University of Athens, Athens, Greece and the IVF Athens Center, a private fertility clinic in Athens, Greece; patients were recruited from March 2017 to July 2018 and February 2018 to December 2019 in the two Units, respectively. All patients have been previously diagnosed with infertility and RIF. All patients met the criteria for undergoing a controlled ovarian hyperstimulation (COH) protocol followed by IVF/ICSI, after a detailed medical history and clinical evaluation. The trial protocol was approved by the Scientific Board and Bioethics Committee of the “Attikon” Hospital [Approval Number: 4/13-3-17 (2140/21-2-17)] and the Scientific Board of IVF Athens Center [Approval Number: 201801/1 (08/01/18)]. Sixty patients were enrolled in this study with data recording on 97 parameters in these couples. The study group comprised of 30 patients with RIF that underwent a hysteroscopic endometrial injury prior to a frozen embryo transfer cycle; another30 patients with RIF underwent a standard frozen cycle with no adjuvant treatment before,consisted the control group. Live birth conformed the primary outcome. Logistic and Poisson regression analysis were implemented to reveal potential independent predictors for all outcomes.
Results: Live birth rates were similar between groups (8/30 vs. 3/30, p=0.0876). Biochemical and clinical pregnancy and miscarriages were also independent of the procedure (p=0.7812, p=0.3436 and p=0.1213, respectively). The only confounding factor that contributed to biochemical pregnancy was the number of retrieved oocytes (0.1618 ± 0.0819, p=0.0481).
Conclusions: The addition of endometrial injury to the freeze all strategy in infertile women with RIF does not significantly improve pregnancy rates, including live birth. A properly conducted RCT with adequate sample size could give a robust answer.
Main subject category:
Health Sciences
Keywords:
Endometrial injury, Hysteroscopy, Freeze-all strategy, Repeated implantation failures, In vitro fertilization (IVF), Pregnancy rates
Number of references:
195
