Recurrent implantation failure might be overestimated without PGT-A
- PDF / 516,180 Bytes
- 2 Pages / 595.276 x 790.866 pts Page_size
- 112 Downloads / 184 Views
CORRESPONDENCE
Recurrent implantation failure might be overestimated without PGT‑A Mauro Cozzolino1,2,3 Received: 13 February 2020 / Accepted: 26 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
I read with interest the article by Bar et al. [1], which indicates that endometrial scratching should be considered as an additional tool for patients with recurrent implantation failure (RIF). It appears especially effective in a particular subgroup of patients with adequate uterine cavities, normal ovarian reserves, optimal ovarian responses to gonadotropin treatment, and high-quality embryos. The authors highlighted the increase rates of clinical pregnancy, implantation, and live birth in patients who had undergone endometrial scratching. The implantation rate in RIF patients rose by between 6% and 44%. Though endometrial scratching may be a useful tool for RIF patients, in the study of Bar et al., the women who underwent to endometrial scratching had a higher percentage of top embryo quality than those who did not receive endometrial scratching (34.8% vs. 19.6%, respectively, p = 0.01). The multivariate analysis showed a link between high-quality embryos and conception [1]. Highquality embryos are central to the definition of RIF. With this in mind, only blastocysts, as opposed to embryos transferred on day 3, should be considered as such. Although, RIF is one of the most common conditions affecting IVF outcomes. There is not universally accepted definition. Concerning the effect of embryo quality on RIF, various techniques have been proposed for selecting the best embryos for transfer. Nowadays, pre-implantation genetic screening (PGT-A) is the only technique capable of defining a normal embryo based on chromosomal status [2]. The major cause of pregnancy loss and implantation failure is based on chromosomal aneuploidies. Although PGT-A could not improve the live birth rate per patient, it reduced the overall incidence of pregnancy loss in patients with RIF [3]. Furthermore, * Mauro Cozzolino [email protected] 1
IVIRMA, IVI Foundation, Valencia, Spain
2
Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
3
Rey Juan Carlos University, Madrid, Spain
Busnelli et al. established that the estimated prevalence of RIF is 15% [3]. The study included a relatively young age group, women between 18 and 39 years old. Although this population has a good prognosis considering the risk of chromosomal abnormalities increases in women over 35. Similarly, during the 2019 ASRM Congress, a study analyzing 4515 patients was presented. In this study, 94.9% of the patients who had up to three consecutive single embryo transfers (SET) of euploid embryos achieved a pregnancy. Implantation or pregnancy rates were highest for the first euploid transfer (69.4%). Implantation rates for the second euploid embryo transfer stood at 59.3%, at 59.2% for the third [5]. This study suggested that true RIF is rare. Given that the implantatio
Data Loading...
