1
|
Cutting ER, Abdallah KS, Mol BW. Is there a treatable cause of repeated implantation failure, or is it simply treatment failure by chance? Reprod Biomed Online 2024; 48:103845. [PMID: 38636349 DOI: 10.1016/j.rbmo.2024.103845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/03/2023] [Accepted: 01/17/2024] [Indexed: 04/20/2024]
Abstract
RESEARCH QUESTION Does repeated implantation failure (RIF) sometimes have a cause, or is it simply treatment failure by chance? DESIGN A hypothetical model of a cohort of 1000 women undergoing four repeated IVF attempts was constructed. A proportion of women with RIF carried an underlying risk factor negatively affecting implantation, compared with women without the factor. In strategy A, women had standard IVF without additional treatment; in strategy B, the women received standard IVF plus an additional treatment. The sensitivity analysis varied the prevalence of the underlying risk factor from 5% to 50%. The model was compared with literature studies where a treatment strategy had been applied. RESULTS With strategy A, the clinical pregnancy rate decreased with subsequent IVF attempts (31% in the first transfer with a risk factor prevalence of 5%, to 8% in the fourth transfer with a risk factor prevalence of 50%). As the prevalence increased, the clinical pregnancy rate was higher with strategy A. For strategy B, the clinical pregnancy rates for the modelled cohort decreased with each subsequent IVF attempt. Regardless of the prevalence of the risk factor, the decline in clinical pregnancy rate was less strong (from 32% in the first transfer with a prevalence of 5%, to 25% in the fourth transfer with a prevalence of 50%). When applying the model to the literature studies, the trends expected for strategy B (decreasing clinical pregnancy rates) were not expressed. CONCLUSIONS RIF might therefore be of iatrogenic origin due to the low success rate of IVF and might be triggered by the increasing female age associated with higher numbers of RIF.
Collapse
Affiliation(s)
- E R Cutting
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.
| | - K S Abdallah
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia; Department of Obstetrics and Gynaecology, Assiut University, Assiut, Egypt
| | - B W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia; Womens and Children's Program Monash Health, Clayton, Melbourne, Victoria, Australia; Aberdeen Centre for Women's Health Research, School of Medicine, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
2
|
Tian Y, Huang J, Wang CC, Lin H, Huang X, Zhao Y, Liu L, Zhang S. The impact of endometrial scratch performed in mid-luteal phase on the endometrium whole genome transcriptomic profiles in following menstrual cycle. HUM FERTIL 2023; 26:733-741. [PMID: 37029627 DOI: 10.1080/14647273.2023.2193909] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 01/21/2023] [Indexed: 04/09/2023]
Abstract
The value of endometrial scratch in women with recurrent embryo transfer has been controversial. Endometrial scratch is often performed in the mid-luteal phase of the cycle preceding embryo transfer but there is little scientific evidence if it affects the whole genome transcriptomic profile of peri-implantation endometrium in the following cycle. A prospective longitudinal cohort study was conducted in a university assisted reproductive unit. A total of eight women with recurrent implantation failure (RIF) were included. Each participant had endometrial biopsy twice, first biopsy on day LH + 7 in natural cycle and second on day LH + 7 of the following cycle. R package was used to identify differentially expressed genes between the sample and enriched gene ontology. However, the paired sample showed no significant difference, neither known endometrial receptive gene set nor other genes, before and after the endometrial scratch. It suggests that endometrial scratch performed during previous mid-luteal phase did not affect the transcriptomic profiles of endometrium on day LH + 7 in women with RIF.
Collapse
Affiliation(s)
- Yichao Tian
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jin Huang
- Department of Obstetrics & Gynecology, the Second Affiliated Hospital, the Chinese University of Hong Kong, Shenzhen, China
- Department of Obstetrics & Gynecology, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chi-Chiu Wang
- Department of Obstetrics & Gynecology, the Chinese University of Hong Kong, Hong Kong SAR, China
- Li Ka Shing Institute of Health Sciences; School of Biomedical Sciences, Hong Kong-Sichuan University Joint Laboratory in Reproductive Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Huizhen Lin
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaona Huang
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yue Zhao
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Liu Liu
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Songying Zhang
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| |
Collapse
|
3
|
Palomba S, Carone D, Vitagliano A, Costanzi F, Fracassi A, Russo T, Del Negro S, Biello A, Di Filippo A, Mangiacasale A, Monaco A, Ranieri A, Ermini B, Barba BF, Castello C, Di Guardo F, Pastorella F, Bernasconi E, Tricarico EM, Filippi F, Polsinelli F, Monte GL, Sosa Fernandez LM, Galletta M, Giardina P, Totaro P, Laganara R, Liguori R, Buccheri M, Montanino Oliva M, Piscopo R, Iuliano A, Innantuoni N, Romanello I, Sinatra F, Liprino A, Thiella R, Tiezzi A, Bartolotti T, Tomasi A, Finocchiaro V, Thiella M, Fuggetta G, Messineo S, Isabella F, Tripodi M, Iaccarino S, La Sala GB, Papaleo E, Caserta D, Marci R, Somigliana E, Guglielmino A. Fertility specialists' views, behavior, and attitudes towards the use of endometrial scratching in Italy. BMC Womens Health 2023; 23:397. [PMID: 37516869 PMCID: PMC10386779 DOI: 10.1186/s12905-023-02564-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 07/22/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND Endometrial scratching (ES) or injury is intentional damage to the endometrium performed to improve reproductive outcomes for infertile women desiring pregnancy. Moreover, recent systematic reviews with meta-analyses and randomized controlled trials demonstrated that ES is not effective, data on the safety are limited, and it should not be recommended in clinical practice. The aim of the current study was to assess the view and behavior towards ES among fertility specialists throughout infertility centers in Italy, and the relationship between these views and the attitudes towards the use of ES as an add-on in their commercial setting. METHODS Online survey among infertility centers, affiliated to Italian Society of Human Reproduction (SIRU), was performed using a detailed questionnaire including 45 questions with the possibility to give "closed" multi-choice answers for 41 items and "open" answers for 4 items. Online data from the websites of the infertility centers resulting in affiliation with the specialists were also recorded and analyzed. The quality of information about ES given on infertility centers websites was assessed using a scoring matrix including 10 specific questions (scored from 0 to 2 points), and the possible scores ranged from 0 to 13 points ('excellent' if the score was 9 points or more, 'moderate' if the score was between 5 and 8, and 'poor' if it was 4 points or less). RESULTS The response rate was of 60.6% (43 questionnaires / 71 infertility SIRU-affiliated centers). All included questionnaires were completed in their entirety. Most physicians (~ 70%) reported to offer ES to less than 10% of their patients. The procedure is mainly performed in the secretory phase (69.2%) using pipelle (61.5%), and usually in medical ambulatory (56.4%) before IVF cycles to improve implantation (71.8%) without drugs administration (e.g., pain drugs, antibiotics, anti-hemorrhagics, or others) before (76.8%) or after (64.1%) the procedure. Only a little proportion of infertility centers included in the analysis proposes formally the ES as an add-on procedure (9.3%), even if, when proposed, the full description of the indications, efficacy, safety, and costs is never addressed. However, the overall information quality of the websites was generally "poor" ranging from 3 to 8 and having a low total score (4.7 ± 1.6; mean ± standard deviation). CONCLUSIONS In Italy, ES is a procedure still performed among fertility specialists for improving the implantation rate in IVF patients. Moreover, they have a poor attitude in proposing ES as an add-on in the commercial setting.
Collapse
Affiliation(s)
- Stefano Palomba
- Sant'Andrea Hospital, University "Sapienza" of Rome, Rome, Italy.
| | | | | | - Flavia Costanzi
- Sant'Andrea Hospital, University "Sapienza" of Rome, Rome, Italy
| | | | - Tiziana Russo
- Grande Ospedale Metropolitano, Reggio Calabria, Italy
- Gatjc Fertility Center, Gioia Tauro, Reggio Calabria, Italy
| | - Serena Del Negro
- Gatjc Fertility Center, Gioia Tauro, Reggio Calabria, Italy
- Presidio Ospedaliero Di Soverato "Basso Ionio", Soverato, Catanzaro, Italy
| | | | | | | | | | | | - Beatrice Ermini
- Centro Italiano Di Procreazione Assistita - CIPA, Rome, Italy
| | | | - Claudio Castello
- Centro FIVET Città Di Torino, Casa Della Salute Valdese, Turin, Italy
| | - Federica Di Guardo
- Azienda Ospedaliero Universitaria Policlinico "G. Rodolico - San Marco", Catania, Italy
| | | | | | | | - Francesca Filippi
- Fondazione IRCCS Ca' Grande - Ospedale Maggiore - University of Milan, Milan, Italy
| | | | - Giuseppe Lo Monte
- Centro Di Medicina Della Riproduzione E Crioconservazione Dei Gameti, Ospedale Di Brunico, Bolzano, Italy
| | | | - Marco Galletta
- Centro Di Procreazione Medicalmente Assistita, Azienda Ospedaliera "Papardo", Messina, Italy
| | | | - Pasquale Totaro
- Centro Di Procreazione Medicalmente Assistita, Ospedale Santa Maria, Bari, Italy
| | | | | | | | | | | | - Assunta Iuliano
- UOC Di Ostetricia E Ginecologia, Azienda Ospedaliera "San Carlo", Potenza, Italy
| | | | - Irene Romanello
- SSD Di Procreazione Medicalmente Assistita, Azienza Sanitaria Friuli Occidentale, Sacile, Pordenone, Italy
| | | | | | | | | | | | | | | | | | - Giuseppa Fuggetta
- SSD Di Procreazione Medicalmente Assistita, Azienza Sanitaria Friuli Occidentale, Sacile, Pordenone, Italy
| | | | | | | | | | | | | | | | | | - Edgardo Somigliana
- Fondazione IRCCS Ca' Grande - Ospedale Maggiore - University of Milan, Milan, Italy
| | | |
Collapse
|