Repeated in vitro fertilization failure: Abnormalities identified in the diagnostic assessment

Objectives. - Investigate the proportion of abnormalities identified on the diagnostic assessment performed after at least two previous failed IVF attempts. Discuss the real benefit of this evaluation. Methods. - Retrospective descriptive study. Between January 2008 and January 2012, 205 couples with at least two consecutive failed IVF attempts had a diagnosis evaluation which consisted in couple's karyotypes; autoimmune and haemostasis biological check-up, pelvic ultrasound-Doppler and hysteroscopy for women. Results. - The main biological anomalies were autoimmune for 23.9% of women: antinuclear antibodies (5.7%), antithyroid peroxidase (11.5%) and antithyroglobulin (8.3%); thrombotic with antiphospholipid antibodies for 8.2% of women (1.4% lupus anticoagulant and 6.8% anticardiolipin antibodies), - and heterozygous prothrombin gene mutation for 9.5%. Karyotypes were abnormal for 2.1% of women and 0% of men. Ultrasound-Doppler appeared to be abnormal in 44.7% of cases (pulsatility index of uterine artery >= 3 and/or protodiastolic notch), and diagnostic hysteroscopy was abnormal in 14.6% of cases. In order to target the real implantation failure, we compared the groups < 8 embryos transferred versus >= 8 embryos transferred and pregnancy after the third or fourth IVF cycle versus no pregnancy, but no statistically significant difference was found. Conclusion. - The diagnostic assessment carried out for recurrent IVF failure can detect biological, karyotypic and morphological abnormalities, in the same proportion that in previous studies. Further studies will have to be conducted to evaluate the real impact of these abnormalities in the recurrent implantation failure and the effectiveness of therapeutic care. (C) 2016 Elsevier Masson SAS. All rights reserved.