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Placement of
Cu-IUD during hysteroscopy for two cycles can up the pregnancy rates in
patients with RIF says results of a study published in July issue of Journal Fertility and Sterility.
Recurrent
Implantation Failure (RIF) is very frustrating for patients and physician both.
Over the decades, few research study have emerged forward about the etiology and
therapeutic options.
Constitutive, as well as mature defects of endometrium
have been put forward as one of the etiology.
Treatments
have largely been costly and empirical, mainly consisting of hysteroscopy,
controlling endometrial infections, evaluating and treating any structural
defects of the uterine cavity, changing the endometrial milieu, alternative
medicines, Low molecular weight heparin and controlled endometrial injury and
immunomodulation.
Controlled
endometrial injury or endometrial scratch has long been used as a treatment
option in recurrent pregnancy loss. The injury results in increased vascularity
and bring about implantation. However, a systematic literature review failed in
establishing definite therapeutic benefits. Diagnostic hysteroscopy also works
along the same line but still lacks robust evidence in its favor.
In this
retrospective study Mao et al. from Shanghai Jiaotong University School of
Medicine, Shanghai, People's Republic of China have evaluated an offbeat
approach for the treatment of RIF.
The team of researchers placed Cu-IUD for
two cycles in women with RIF while they were undergoing hysteroscopy.
They
postulated that even after removing the IUD after two cycles, the altered
endometrial environment because of foreign body persists much like the
‘endometrial scratch.’
The study
recruited 440 women, with a history of at least two failed embryo transfers
with good quality embryos. At the time of diagnostic hysteroscopy, the patients
were offered a choice of getting a IUD for two months.
Out of
which, 382 patients opted for IUD, while 58 patients refused the treatment
option. All 382 patients underwent a repeat diagnostic and, if needed,
therapeutic hysteroscopy followed by frozen embryo transfer cycle.
The
demographics of both the groups were similar. Women who opted for IUD had a
significantly higher implantation rate (29.29% vs. 16.56%), chemical pregnancy
rate (53.25 vs. 41.38%), and clinical pregnancy rate (45.13% vs. 26.44%) than
the non-IUD group.
After
multivariate regression analysis, chemical pregnancy rates were significantly
more in IUD users. It was also interesting to note a higher number of IUD users
suffered from some kind of uterine pathology like polyps, endometritis and
polypoid proliferations but, they did not affect the clinical pregnancy rate.
The study
has several limitations in the way of sample size, selection bias and retrospective
nature along with confounding effect of second look hysteroscopy in IUD users.
The IUD use also may have prevented further adhesions formation in that group.
The question
about the type of endometrial injury, duration of foreign body in situ and type
of changes in the endometrium that is beneficial in increasing endometrial
receptivity remain unanswered.
But, this
study does bring forward a novel treatment option that is worth investigating in
future.
Primary
Source: Novel approach to recurrent implantation failure: short-term copper
intrauterine device placement
Goodman,
Linnea R. et al.
Fertility
and Sterilit , Volume 108 , Issue 1 , 42 - 43
