Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Efficacy doubts over pre-IVF hysteroscopy

30.06.2014

Results from a large randomised European trial

A large multicentre trial seems finally to have resolved one of IVF's long-running controversies - whether the outlook for women with a poor IVF record can be improved by routine hysteroscopy performed before further IVF treatment.(1)

For the TROPHY study, whose results are reported today at the 30th Annual Meeting of ESHRE in Munich by Dr Tarek El-Toukhy from Guy's and St Thomas's Hospital, London, has now found no significant difference in IVF success rates between those who had outpatient hysteroscopy performed before their IVF and those who didn't. "Based on these findings, outpatient hysteroscopy before IVF doesn't significantly improve IVF results and cannot be considered essential for women with recurrent IVF failure," said Dr El-Toukhy.

Only around one-third of IVF cycles achieve a pregnancy, and unsuccessful attempts (implantation failure) can usually be explained by embryonic or uterine factors. As a result, outpatient hysteroscopy is performed routinely in many fertility clinics before further attempts, first diagnostically to visualise the surface of the uterus and check for any abnormal growths, and then operatively during the same procedure to remove these growths. Several studies have suggested that this can be beneficial prior to further IVF.

However, the TROPHY study has now found such benefit to be less than previously suggested.

This was a large randomised trial performed in eight IVF centres in Europe between 2010 and 2013. More than 700 women were randomised to IVF with hysteroscopy (in the preceding cycle), or IVF without; all were under the age of 38, without known uterine pathology, and had history of unsuccessful IVF (two to four failed cycles).

First, results showed that some abnormality of the uterine cavity was found in 11% of the patients having hysteroscopy.

Second, outcome results following IVF showed no significant difference between the two groups - a live birth rate per patient of 31% in the hysteroscopy group and 29% in the control group.

"The results indicate that routine outpatient hysteroscopy prior to IVF in women who have experienced two to four failed IVF attempts do not significantly improve the subsequent IVF outcome," said Dr El-Toukhy. However, he acknowledged that other studies had indicated that hysteroscopy may well be beneficial before IVF. For example, a meta-analysis performed by Dr El-Toukhy himself in 2008 had provided some evidence that outpatient hysteroscopy might improve IVF results.(2)

However, if the gold standard of a randomised trial has now failed to show any significant benefit of outpatient hysteroscopy before IVF, where might the source of any benefit lie? "It is possible that endometrial scratching rather than routine outpatient hysteroscopy could be responsible for the previously reported improvements," said Dr El-Toukhy, referring to a procedure which too has raised controversy in recent years. Several studies - and study reviews - have shown that "injury" to the surface of the uterus (endometrium), which includes scratching, biopsy or even hysteroscopy, may improve implantation following embryo transfer in IVF.

One recent review of endometrial scratching described endometrial receptivity as one of the key factors regulating embryo implantation and proposed "that mechanical trauma to the endometrium alters gene expression, enhances secretion of growth factors and makes it more receptive for implantation".(3) Results of the review suggested that endometrial scratching is 70% more likely to result in pregnancy than no treatment. A more recent review - but examining the same studies - concluded that "hysteroscopy and/or endometrial scratching in the cycle preceding ovarian stimulation should become a standard for patients with [recurrent implantation failure]. The optimal timing and number of scratches remains to be determined in randomized controlled trials".(4)

Commenting on the impact of hysteroscopy in women with recurrent implantation failure in IVF, Dr El-Toukhy explained that in this study it was mainly applied diagnostically - although "when an abnormality was found and deemed treatable by the surgeon, it was treated either at the same hysteroscopy or at a latter date under anaesthetic". In view of the neutral results of the study it seems possible that some of the abnormalities found "had little clinical significance" - although the study was not designed to test this.

Meanwhile, infertile women with recurrent IVF failure in IVF remain a challenging treatment group, with still little consensus on how they might best be treated.

###

Abstract O-066, Monday 30 June 17.00 CET

A multi-centre randomised study of pre-IVF outpatient hysteroscopy in women with recurrent IVF-ET failure: The TROPHY Trial

Notes

Outpatient hysteroscopy is one of the common investigations proposed after recurrent IVF failure. It is a well-tolerated minimally-invasive procedure, which allows visual assessment of the cervical canal and uterine cavity and provides the opportunity to perform therapy at the same time. Intrauterine pathologies, such as polyps, have been shown to be present in up to 25% of infertile patients, and can be a valid reason for implantation failure. Thus, routine hysteroscopy prior to IVF has been suggested by a number of investigators to ensure normality of the uterine cavity before embryo transfer.

2. El-Toukhy T, Sunkara SK, Coomarasamy A, et al. Outpatient hysteroscopy and subsequent IVF cycle outcome: a systematic review and meta-analysis Reprod Biomed Online 2008; 16: 712-719.

3. Potdar N, Gelbaya T, Nardo LG. Endometrial injury to overcome recurrent embryo implantation failure: a systematic review and meta-analysis. Reprod Biomed Online 2012; 25: 561-571.

4. Implantation in assisted reproduction: a look at endometrial receptivity. Reprod Biomed Online 2013; 27: 530-538.

When obtaining outside comment, journalists are requested to ensure that their contacts are aware of the embargo on this release.

For further information on the details of this press release, contact:
Christine Bauquis at ESHRE
Mobile: +32 (0)499 25 80 46
Email: christine@eshre.eu

Christine Bauquis | Eurek Alert!

Further reports about: Embryology IVF Reproduction endometrial failure procedure

More articles from Health and Medicine:

nachricht Organ-on-a-chip mimics heart's biomechanical properties
23.02.2017 | Vanderbilt University

nachricht Researchers identify cause of hereditary skeletal muscle disorder
22.02.2017 | Klinikum der Universität München

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Breakthrough with a chain of gold atoms

In the field of nanoscience, an international team of physicists with participants from Konstanz has achieved a breakthrough in understanding heat transport

In the field of nanoscience, an international team of physicists with participants from Konstanz has achieved a breakthrough in understanding heat transport

Im Focus: DNA repair: a new letter in the cell alphabet

Results reveal how discoveries may be hidden in scientific “blind spots”

Cells need to repair damaged DNA in our genes to prevent the development of cancer and other diseases. Our cells therefore activate and send “repair-proteins”...

Im Focus: Dresdner scientists print tomorrow’s world

The Fraunhofer IWS Dresden and Technische Universität Dresden inaugurated their jointly operated Center for Additive Manufacturing Dresden (AMCD) with a festive ceremony on February 7, 2017. Scientists from various disciplines perform research on materials, additive manufacturing processes and innovative technologies, which build up components in a layer by layer process. This technology opens up new horizons for component design and combinations of functions. For example during fabrication, electrical conductors and sensors are already able to be additively manufactured into components. They provide information about stress conditions of a product during operation.

The 3D-printing technology, or additive manufacturing as it is often called, has long made the step out of scientific research laboratories into industrial...

Im Focus: Mimicking nature's cellular architectures via 3-D printing

Research offers new level of control over the structure of 3-D printed materials

Nature does amazing things with limited design materials. Grass, for example, can support its own weight, resist strong wind loads, and recover after being...

Im Focus: Three Magnetic States for Each Hole

Nanometer-scale magnetic perforated grids could create new possibilities for computing. Together with international colleagues, scientists from the Helmholtz Zentrum Dresden-Rossendorf (HZDR) have shown how a cobalt grid can be reliably programmed at room temperature. In addition they discovered that for every hole ("antidot") three magnetic states can be configured. The results have been published in the journal "Scientific Reports".

Physicist Dr. Rantej Bali from the HZDR, together with scientists from Singapore and Australia, designed a special grid structure in a thin layer of cobalt in...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Booth and panel discussion – The Lindau Nobel Laureate Meetings at the AAAS 2017 Annual Meeting

13.02.2017 | Event News

Complex Loading versus Hidden Reserves

10.02.2017 | Event News

International Conference on Crystal Growth in Freiburg

09.02.2017 | Event News

 
Latest News

Stingless bees have their nests protected by soldiers

24.02.2017 | Life Sciences

New risk factors for anxiety disorders

24.02.2017 | Life Sciences

MWC 2017: 5G Capital Berlin

24.02.2017 | Trade Fair News

VideoLinks
B2B-VideoLinks
More VideoLinks >>>