Fertil Steril. 2016 May; 105(5): 1307-1313

Zachary P. Demko, Ph.D.,a Alexander L. Simon, B.S.,a Rajiv C. McCoy, Ph.D.,b Dmitri A. Petrov, Ph.D.,c and Matthew Rabinowitz, Ph.D.  Natera, Inc., San Carlos, California; b Department of Genome Sciences, University of Washington, Seattle, Washington; and c Department of Biology, Stanford University, Stanford, California

Abnormal chromosome number is very common in human embryos and is responsible for IVF failures and miscarriages.  ZP Demko et al. published in Fertility Sterility a study of preimplantation genetic screening of embryos from different IVF clinics. The significance of the study comes from the large number of embryos examined from different IVF clinics and the comprehensive technique they used such as single nucleotide polymorphism (SNP) arrays for all 24 chromosomes.

The mean percentage of embryos with normal chromosome numbers (euploid) was about 60 %, steady from 25 to 35 years of maternal age. But after 35 years there was a steep decline reaching a small single digit number and frequently zero at the age of 45. This is crucial information to advice, explain and set realistic expectation during IVF treatments.

https://pubmed.ncbi.nlm.nih.gov/26868992/

Lancet. 2016 Jun 25;387(10038):2614-2621.

Hysteroscopy is an invasive procedure for diagnosis and treatment of abnormal findings in the endometrial cavity recognized by detailed transvaginal U/S.  However hysteroscopy has been also widely suggested by infertility specialists for women with normal U/S before or after failed IVF cycle as a step to increase success in IVF. Two well-conducted, multicenter, randomized controlled trials, “inSIGHT” and “TROPHY”, have been published in Lancet addressing this IVF add-on.

Both studies revealed that routine hysteroscopy before and after an IVF failure suggested for women with normal endometrial cavity as observed by transvaginal U/S, does NOT improve live birth rates. Since hysteroscopy is an invasive and relative expensive procedure such an approach must be properly and extensively justifiable.

https://www.ncbi.nlm.nih.gov/pubmed/27132053

Lancet. 2016 Jun 25;387(10038):2622-2629.

Hysteroscopy is an invasive procedure for diagnosis and treatment of abnormal findings in the endometrial cavity recognized by detailed transvaginal U/S.  However hysteroscopy has been also widely suggested by infertility specialists for women with normal U/S before or after failed IVF cycle as a step to increase success in IVF. Two well-conducted, multicenter, randomized controlled trials, “inSIGHT” and “TROPHY”, have been published in Lancet addressing this IVF add-on.

Both studies revealed that routine hysteroscopy before and after an IVF failure suggested for women with normal endometrial cavity as observed by transvaginal U/S, does NOT improve live birth rates. Since hysteroscopy is an invasive and relative expensive procedure such an approach must be properly and extensively justifiable.

https://www.ncbi.nlm.nih.gov/pubmed/27132052

N Engl J Med. 2019 Jan 24;380(4):325-334.

Endometrial scratching (ES) is an IVF adds-on procedure widely adopted by infertility specialists claiming improvement of IVF results. Lensen S et al. published in NEJM a well conducted, multicenter, randomized controlled trial addressing the role of endometrial scratching in IVF. The study had the power to detect a between group differences in live births about a reasonable 7%. They concluded that ES before IVF has no effect on live birth rates. Therefore, offering ES before IVF and charging patients for it is very questionable. 

https://www.ncbi.nlm.nih.gov/pubmed/30673547