Arefi، Soheila نويسنده , , Soltanghoraee، Haleh نويسنده Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR , , Zarnani، AmirHassan نويسنده Reproductive Immunology Department, Reproductive Biotechnology Research Center, Avicenna Research Institute, Avesina Infertility Center, Tehran, Iran. , , Sadeghpour Tabaei، Ali نويسنده Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences , , Ghaffari Novin، Marefat نويسنده , , Zeraati، Hojat نويسنده Department of Biostatistics and Epidemiology, Tehran University of Medical Sciences, Tehran, Iran. , , Ebadi، Pegah نويسنده ,
Background: Despite numerous developments in the field of assisted reproduction, the
implantation rate remains low. Among the various reasons of implantation failure,
endometrial regularity has an important role. Hysteroscopy is an accurate method for
evaluating the endometrial characteristics, with the ability to treat uterine pathology.
Objective: The aim of the present study was to evaluate the findings on hysteroscopy
and thereafter the result of subsequent IVF/ICSI in infertile women with the history of
frequent unexplained and unsuccessful IVF/ICSI attempts.
Materials and Methods: In this observational study, the hysteroscopy findings and the
outcomes of subsequent IVF/ICSI were evaluated in 89 infertile women admitted in
Avicenna Infertility Clinic, with previous repeated (more than two) failed IVF/ICSIETs,
including the patients with normal Hysterosalpinography (HSG) and excluding
severe male factor infertility and also thrombophilia, genetic and immunologic
problems. The data were analyzed with SPSS software and Fisher exact, chi-square, and
Results: In 53 (59.5%) cases, hysteroscopy revealed abnormal intrauterine findings
including adhesions 7 (13.7%), single polyp 11 (20.7%), endometrial polyposis 10
(18.8%), endometrial hyperplasia 10 (18.8%), uterine cavity hypoplasia 4 (7.8%) and
myoma 5 (9.8%). These abnormalities were significantly higher in women with more
than 8 years of infertility (chi-square=4.7, p-value=0.03). After hysteroscopy and
subsequent IVF/ICSI-ET attempt using standard long protocol, pregnancy rate were
significantly higher compared with the previous repeated IVF/ICSI attempts (35.8%
Conclusion: According to this study, we strongly suggest evaluation of endometrial
integrity by hysteroscopy in patients with repeated IVF/ICSI-ETs failure, before
entering any other fertilization procedures.