FEI – a new approach in the therapy of implantation failure?

Absolutely, the method is used for all purposes. We are using the fundus endometrial incision in every case, although we prefer to use this method after one embryo transfer failure. We propose a hysteroscopic examination and fundus endometrial incision to every patient. When we have the leftover embryos or blastocysts after a failed embryo transfer, and hysteroscopy was not done. It works in every case, not only in the case of egg donation. Before the second embryo transfer, it is absolutely necessary to use this technique.

Some steps need to be taken. The first is the synchronization with your future embryo transfer cycle, we are performing the hysteroscopy before the embryo transfer, and the embryo transfer must be done in the next cycle or the third cycle. Only then the influence of the fundus incision gives the best results. After two cycles probably, this method is not going to work well. Secondly, this is a technique, which is very well performed, and with this, we have a very good view of the uterus, but it’s not only to see it, the point is to perform this incision in the fundus. This is the reaction from the endometrium, and due to this reaction, we have these benefits. It’s impossible to compare this technique with every simple diagnostic hysteroscopy. This is an advanced technique and more sophisticated. I try to cooperate with some doctors in the UK who can follow our steps and follow our advice. We performed some hysteroscopies this way with quite good results. After that, our transfers here in Thessaloniki were successful. The technique is not very difficult, but some points are required, like performing in the follicular phase of the cycle, from day 6 to day 10, and the embryo transfer must be performed in the second one, or the third cycle measuring from this point.

It’s also possible to perform this technique in the natural cycles, but it is better to use frozen embryos in this case. We collect the eggs and embryos afterward in the natural cycle, vitrify them at the blastocyst stage, and we perform this hysteroscopy procedure in the next cycle, and then in the third cycle, we try to transfer the embryos.

This technique is possible to be used in a woman with fibroids. However, it depends on the location of the fibroid, and if the fibroids are very close to the cavity. This is a general problem with embryo transfers, but if fibroids are endo-muscular or are in the uterus wall, there is no reason to connect the hysteroscopy with embryo transfer and not extracting these fibroids. Very small submucous, it’s no problem, we also have 2,3 cases with extracting small submucous fibroids during the hysteroscopy, it depends on the operator experience.

Yes, we use it but very rarely. If there is a case where the patient needs to use this technique, yes, we do it.

Absolutely, it’s the same, but in every case, I would like to say it again, that the better way and the better results we get if we have the euploid embryos. In every case that we are going through IVF failure cycles or failure with embryo transfer, it is a very smart step to use the PGT-A technique to be absolutely sure that you are using the euploid embryos. If we have the euploid embryos, then the hysteroscopic procedure is very important, and we are talking about 10% and more.

Generally, the technique is available everywhere. Anyone who wants to perform this procedure is able to do it. I’m sure that it will be very popular next year after our presentations and after our research, it will be more popular, and probably it will be available in every country.

This is another issue. We are absolutely sure of using a hysteroscopy before the embryo transfer for cervix opening, and it will be performed with sedation, it’s very comfortable for the patient, without any pain, and this is also the experience for the operator. In the case of embryo transfer having all this information about the cervix and about the uterus is very important for the operator, it’s helping him to perform the embryo transfer, properly, and without any pain for the patient.  It’s possible to have lower implantation rates after a very difficult embryo transfer with difficulties in opening the cervix or going through into the cavity, yes, absolutely it’s possible, and we also prefer to use the hysteroscopy before.

Generally, we haven’t got any problems until now using these techniques. It depends on the operator experience but using these modern hysteroscopies with a very thin injection needle, it’s about 4 millimeters.It’s very rare to have some complications during the hysteroscopy.

In our unit, the cost is 1200EUR per procedure, all in the package.