The Impact of Diagnostic Hysteroscopy on Treatment Outcomes in Patients with Recurrent IVF Failure

BACKGROUND/AIMS: To assess whether diagnostic hysteroscopy, performed alone or in combination with endometrial scratching, influences reproductive outcomes in women with recurrent implantation failure (RIF). MATERIALS AND METHODS:This retrospective cohort study included women with unexplained infertility who experienced recurrent in vitro fertilization failures despite transfer of good-quality embryos.All patients had normal uterine imaging prior to enrollment.Diagnostic hysteroscopy was performed in all cases; and patients were divided into two groups according to whether endometrial scratching was also performed.Baseline demographic characteristics, stimulation parameters, embryological outcomes, and pregnancy results were compared between groups. RESULTS:Baseline clinical and hormonal profiles were comparable between the two groups.While luteinizing hormone levels on the trigger day were modestly higher in the scratching group, other stimulation characteristics and embryological outcomes did not differ significantly (p>0.05).Although the scratching group had higher biochemical, clinical, and live-birth rates than the non-scratching group, the difference in overall pregnancy outcomes was not statistically significant (p=0.172). CONCLUSION:In this selected cohort of women with RIF, endometrial scratching performed during diagnostic hysteroscopy did not significantly improve pregnancy or live-birth rates.These findings suggest that the benefit of endometrial scratching may be limited and highly dependent on patient selection.Larger, prospective, randomized studies that incorporate molecular markers of endometrial receptivity are needed to identify subgroups that may benefit from this intervention.