Improving endometrial receptivity: Does hysteroscopy in the cycle prior help to improve implantation and clinical pregnanacy.

OBJECTIVE: Mechanical endometrial injury is proposed to induce and modulate expression of genes for factors required for improving implantation. Hysteroscopy also provides reassurance and opportunity for treatment of uterine pathology. However, with a lack of large sized RCTs, recommendation is based on meta-analysis, using non randomized or quasi randomized studies, which have used non-matched controls. We sought to identify whether a normal hysteroscopy in the cycle preceding transfer (fresh or frozen) would have a beneficial impact on the implantation and clinical pregnancy rate after matching for variables known to affect pregnancy rates. DESIGN: Case -controlled study. MATERIALSAND METHODS: Case controlled study of women undergoing hysteroscopy, during IVF treatment in the last 4 years in one clinician's practice. All patients with no abnormality detected at hysteroscopy followed by transfer in the next cycle (n= 87) were matched with controls in a 3:1 ratio(no=263). Matching included age, cycle and treatment number, stimulation protocol, IVF/ICSI and Fresh/Frozen embryos transferred, and day of transfer. Statistical analysis was performed with Fischer's exact test. RESULT(S):Mean age in the hysteroscopy and control group was comparable: 36.2 yrs. and 36.3 years respectively. The only biochemical positive pregnancy rate per transfer in the intervention group was 5.9, in controls 7.1 (p=NS), pregnancy rate per transfer 28.2 in the intervention group versus 20.9(p= NS, stratification of fresh versus frozen was non-significant (21.7:21.4; 35.9:20.2). A further comparison stratifying for age subgroups and cycle numbers did not show any benefits in the intervention group. CONCLUSION(S): Mechanical intervention with hysteroscopy did not show a statistical significance in terms of implantation or pregnancy when matched with controls for confounding variables .Although there was a probable trend of more pregnancies in the frozen transfers following hysteroscopy, this s