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Clinical and Experimental Obstetrics & Gynecology  2020, Vol. 47 Issue (5): 723-728    DOI: 10.31083/j.ceog.2020.05.5390
Original Research Previous articles | Next articles
Office hysteroscopy in cases of recurrent implantation failure; Do or not to do
M. Elmahdy1, *(), I. Elfourtia2, H. Maghraby1
1Alexandria University, Obstetrics and Gynecology Department, Alexandria, Egypt
2Libya Ministry of Health, Misurata, Libya
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Objective: To assess the management and outcome of office hysteroscopy in patients experiencing recurrent implantation failure (RIF) with two or more intra cytoplasmic sperm injection (ICSI) failures. Study design: The prospective study was conducted at Elshatby maternity university hospital and Misrata National Center for Infertility, Misrata, Libya. One hundred and seventy-five female patients aged below 40 years and with 2 or more previous ICSI failures, with ≥ 2 fresh embryos transferred per attempt were included in the study. Office hysteroscopy was done in all patients to assess the endometrial cavity for any abnormal uterine findings and clinical pregnancy rate after hysteroscopy was evaluated. At the end of hysteroscopy, endometrial biopsy was done to observe prevalence of any different inflammatory cells, plasma cells or lymphocytes. Results: Out of 175 patients, 135 had abnormal hysteroscopic findings with single and combined pathologies. Endometritis 43 (65%) and septum with endometritis 34 (49%) were the most common pathologies observed. After office hysteroscopy, 13 (19.6%) women with single pathology and 13 (18.8%) women with combined pathologies became pregnant. Of the 175 patients studied, pregnancies occurred in 33 (18.8%) women with two or more ICSI failures after corrected endometrial pathology by hysteroscopy. Conclusion: Office hysteroscopy is a good diagnostic and therapeutic tool in cases of recurrent implantation failure. It has the potential to improve pregnancy rate in these patients.

Key words:  Recurrent implantation failure      Office hysteroscopy      ICSI failures      Clinical pregnancy     
Submitted:  27 September 2019      Accepted:  27 February 2020      Published:  15 October 2020     
*Corresponding Author(s):  M. Elmahdy     E-mail:

Cite this article: 

M. Elmahdy, I. Elfourtia, H. Maghraby. Office hysteroscopy in cases of recurrent implantation failure; Do or not to do. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(5): 723-728.

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Figure 1.  — Flow chart.

Table 1  — Baseline clinical and hormonal profile of the patients.
Parameters Values (n = 175)
Mean age (years) ± SD 34.4 ± 4.6
E2 levels on basal day 3 (pg/mL) 46.1 ± 35.6
AMH (pmol/L) 3.3 ± 3.2
FSH (IU/L) 7.7 ± 3.4
LH (IU/L) 5.4 ± 2.4
Prolactin (IU/L) 18.7 ± 14
TSH (IU/mL) 2.7 ± 2.2
Table 2  — Pregnancy in single pathologies after office hysteroscopy.
Hysteroscopic findings Number of cases (%) Number of pregnant (%)
Endometritis 43 (65%) 7 (16.3%)
U1* 3 (4.5%) 1 (33.3%)
U2a* 10 (15%) 4 (26.7%)
U3a* 2 (3%) 0 (0%)
Polyp 4 (6%) 0 (0%)
Adhesions 4 (6%) 1 (20%)
Total 66 (100%) 13 (19.6%)
Table 3  — Pregnancy in combined pathologies after office hysteroscopy.
Findings Number of cases (%)
Number of pregnant (%)
Septum U2a + endometritis 34 (49%) 10 (29.4%)
Septum U3 + endometritis 3a(4%) 1 (33.3%)
Polyp + Septum U2a 11 (15%) 1 (9.9%)
Polyp + endometritis 14 (20%) 1 (7.1%)
Three 7 (10.4%) 0 (0%)
Total 69 (100%) 13 (18.8%)
Table 4  — Pregnancy in number of failed ICSI after office hysteroscopy.
No. of counts
(% within number of failed ICSI)
Pregnancy Total
No Yes
2 count 78 (79.59%) 20 (20.41%) 98 (100.0%)
3 count 28 (77.8%) 8 (22.2%) 36 (100.0%)
4 count 20 (83.3%) 4 (16.7%) 24 (100.0%)
4 + count 16 (94.11%) 1 (5.89%) 17 (100.0%)
Total count
(% within number of failed ICSI)
142 (81.1%) 33(18.8%) 175 (100.0%)
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