Hysteroscopic Endometrial Fundal Incision in Oocyte Recipients before Embryo Transfer May Improve Reproductive Outcomes: A Prospective Study

Induced endometrial injury is a technique described that have positive impact on implantation. The aim ofthis study was to investigate whether hysteroscopic endometrial fundal incision (EFI) in oocyte recipients before embryotransfer increases pregnancy and live birth rates or not. A prospective study was conducted between 2014 and 2019 at an in vitro fertilization (IVF) unitin Greece. As part of the protocol, hysteroscopy and EFI were offered to all the egg recipients and the outcomes comparedwith those from an older cohort from the same Unit not undergoing hysteroscopy. In total, 332 egg recipients participated in the study; 114 of them underwent EFI prior to embryo transfer. Bothgroups were similar in terms of age, years of infertility, duration of hormone replacement treatment (HRT) and numberof blastocysts transferred. In the EFI group, minor anomalies were detected and treated in 6.1% (n=7) of the participants.Moreover, pregnancy test was positive in 73.7% of the women in the hysteroscopy group compared to 57.8% in the nonhysteroscopygroup (P=0.004). Live birth rate was also higher (56.1 vs. 42.2%, P=0.016) in the EFI group compared tothe non-hysteroscopy one. Apart from the obvious benefit of recognizing obscured anomalies, requiring surgical correction, it appearsthat in oocyte recipients prior to embryo transfer, EFI might improve uterine receptivity and reproductive outcomes.