In recent years with the continuous improvement of ART technology, it has brought new hope to infertile couples, however more than half of the patients still experience multiple transfer failures. Abnormalities in the structure of the uterine cavity are one of the main factors that lead to the failure of embryo implantation. Hysteroscopic metroplasty with cold scissors is an innovative technique of our team, in which micro-scissors are used in the procedure instead of the previous electric knife. Our previous study found that this technique has the effect of improving fertility outcomes in patients with T-shaped uterus. Based on the previous study, this study is an open randomized controlled trial to include patients with more than 2 or more ART implantation failures. For the first time, cold knife hysteroscopic hysterectomy was used to treat patients with cryptic uterine stenosis in patients with repeated RIF implantation failures to assess the clinical efficacy of the technique and to investigate the effect of this technique on the pregnancy outcome of reimplantation of embryos in patients with repeated ART implantation failures. Meanwhile, this project is the first to study the diagnostic value of transvaginal 3D ultrasound/MRI for the assessment of uterine cavity status in patients with RIF, with a view to exploring the value of noninvasive imaging as an alternative to invasive hysteroscopy in the clinical management of RIF. The aim of the study is to provide a reference for early diagnosis and treatment of patients with repeated ART implantation failures, and to improve the pregnancy outcome of their reimplanted embryos.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
200
If the uterine cavity is normal during intraoperative hysteroscopy, the operation will be finished and embryo transfer will be scheduled in 1 month after the operation; if the uterine cavity is narrowed or the uterine wall is coalesced, hysteroscopic metroplasty and IUD placement will be performed, and a second hysteroscopy with IUD retrieval will be performed after 2-month postoperative estrogen-progesterone treatment, then embryo transfer will be scheduled after 1-month estrogen-progesterone treatment.
Shanghai First Maternity and Infant Hospital
Shanghai, Shanghai Municipality, China
Pregnancy rate
Proportion of patients whose blood β-hCG test is positive after embryo transfer
Time frame: From enrollment to the 18 months after the last embryo transfer
Biochemical pregnancy rate
Proportion of patients who have elevated blood β-hCG (\> 25 mIU/mL) or positive urine immunopregnancy test, but ultrasound test reveal no gestational sac.
Time frame: From enrollment to the 18 months after the last embryo transfer
Clinical pregnancy rate
Proportion of patients who have fetal primitive heart tube pulsation tested with ultrasonography 4 weeks after embryo transfer.
Time frame: From enrollment to the 18 months after the last embryo transfer
Fetal implantation rate
Proportion of transfered embryos which develop into intrauterine gestational sacs.
Time frame: From enrollment to the 18 months after the last embryo transfer
Miscarriage rate
Proportion of patients with unintentional termination of intrauterine pregnancy at 28 gestational weeks.
Time frame: From enrollment to the 18 months after the last embryo transfer
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.