OC11.05: Findings at transvaginal scan performed by experts after IVF recurrent implantation failure

Recurrent implantation failure (RIF), defined as at least 2 or more implantation failure after single embryo transfer (ET) of good quality embryos, is very distressing for couples and frustrating for their clinicians. The aim of this study is to evaluate the presence of undiagnosed pelvic diseases by high-quality transvaginal sonography (TVS) performed by experts in patients who underwent IVF and had RIF. This retrospective study include infertile patients aged between 30 and 45 years who underwent IVF in different European centres. All patients included had RIF after a single ET at blastocyst stage of an euploid blastocyst (PGT-A) or a blastocyst from oocyte donation. 2D, 3D and power Doppler TVS, were performed by a single gynecologist, expert in TVS. Of 178 patients with RIF final 132 met all the inclusion criteria (40.5 ± 5.4 yrs). TVS after RIF revealed a normal pelvic scan in only 17%. A significant difference was observed through the already known abnormal TVS group before IVF (Group A) and the new diagnosis after RIF (Group B) (25% vs 83%, p < 0.0001). We divided the pelvic pathologies known before IVF and seen after RIF at TVS in 3 groups: uterine abnormalities (20% vs 69%, p < 0.001), adnexal lesions (10% vs 30%, p = 0.001), presence of DIE (4% vs 39%, p < 0.001). Regarding the uterine abnormality the following differences between the two groups were observed: adenomyosis (8% vs 52%, p < 0.001); myomas (17% vs 22%, p = 0.31); dysmorphic uteri (0.7% vs 11%, p = 0.0004), subseptate uteri (0% vs 5%, p = 0.009). Concerning adnexa abnormalities, a significant difference was observed for both hydrosalpinx (0% vs 9%, p = 0.0004) and endometriomas (10% vs 24%, p = 0.003). 30% of patients know to have endometriosis but do not know to be affected by DIE and adenomyosis as well. TVS performed with high level expertise in RIF patients, could contribute to a new diagnosis of pelvic organic disease which could potentially be treated and change the destiny of ET. Expert TVS should be probably performed always before the first ET and not only after RIF.