Hysteroscopic endometrial fundal incision versus hysteroscopy only in oocyte recipients: A randomized controlled trial assessing the reproductive outcomes

Articles in Press

Document Type : Original Article

Authors

1 Assisting Nature Centre of Reproduction and Genetics, Thessaloniki, Greece

2 1 Assisting Nature Centre of Reproduction and Genetics, Thessaloniki, Greece 2 Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece

3 Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece

10.22074/ijfs.2024.2009369.1523

Abstract

Background: Endometrial scratching (ES) remains controversial regarding its potential effectiveness in improving pregnancy rates. The objective of the present study was to assess the impact of endometrial fundal incision (EFI) during hysteroscopy on reproductive outcomes in a population of oocyte recipients.

Materials and Methods: A prospective randomized controlled trial was conducted between 2020 and 2023 at the Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki and “Assisting Nature Centre of Reproduction and Genetics”. The study population consisted of women who underwent hysteroscopy randomly assigned in a 1:1 ratio to either EFI (one to three months before embryotransfer with donor oocytes) or no intervention throughout office hysteroscopy. Clinical pregnancy and live birth rates were the primary outcomes.

Results: After the exclusion of patients with intraoperative diagnosed endometrial pathology, a total of 124 women underwent randomization. Pregnancy test was positive in 79% (n=49/62) of the women in the EFI compared to 59.7% (n=37/62) in the hysteroscopy-only group (p=0.019). The live birth rates did not differ between the two groups (58.1%; n=36/62 vs 51.6%; n=32/62; p=0.470), but first trimester miscarriage rate was higher in the EFI compared to the hysteroscopy-only group (20.9%; n=13/62 vs 6.5%; n=4/62; p=0.018).

Conclusion: EFI during hysteroscopy seems to improve pregnancy rates in oocyte recipients without intrauterine pathology, while it also increases early miscarriage rates. Live birth rates are not affected by the EFI. These results should be interpreted with caution before the implementation of EFI in the routine IVF practice.

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International Journal of Fertility and Sterility

Articles in Press, Accepted Manuscript
Available Online from 12 February 2024

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