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

Robert Najdecki, MD, PhD
Co-Founder & Scientific Director at Assisting Nature , Assisting Nature – Human Reproduction & Genetics

Embryo Implantation, Failed IVF Cycles

FEI - new aproach for implantation failure
From this video you will find out:
  • What is hysteroscopic scratching and how it works?
  • What is the timeline of this procedure?
  • Why there is no common consensus on endometrial scratch among doctors?
  • How does Hysteroscopic Fundus Endometrial Incision work?
  • What are the benefits of FEI?

What is Hysteroscopic Fundus Endometrial Incision?

In this session, Dr. Robert Najdecki, Co-Founder & Scientific Director at Assisting Nature, Thessaloniki, Greece has introduced a new technique called FEI (Hysteroscopic Fundus Endometrial Incision) that is aspiring to replace the traditional endometrial scratching.

What is Hysteroscopic Fundus Endometrial Incision? - Questions and Answers

Can we use this method with our own eggs and not donor eggs?

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.

I am 36 years old, I have one endometrial cyst. I had one failed PGT tested FET. I have 2 embryos left, which are PGT tested. How Hysteroscopic Fundus Endometrial Incision (FEI) is different than standard hysteroscopy? As I have already gone through hysteroscopy.

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.

Can a patient do FEI with a natural cycle?

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.

Could this technique be used for women with fibroids?

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.

What about Platelet Rich Plasma therapy? Do you use that?

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

Do you know the increase in success rates with own eggs using this FEI method? Is it +10% as well?

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.

Is this technique available in the US (FEI)?

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.

During the last transfer, the doctor was having a problem with opening my cervix as it is too tight, which resulted in pain during the FET transfer. Could it be the reason for the failed transfer? Is this technique (FEI) beneficial in such a scenario?

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.

Is there any risk for scars using these FEI techniques?

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.

What are the costs of this procedure (FEI)?

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

Robert Najdecki, MD, PhD

Robert Najdecki, MD, PhD

Robert Najdecki MD, Ph.D. is a Reproductive Gynaecology Specialist. His experience in diagnosis and treatment of fertility disorders, such as endoscopic surgery is long and extensive and includes more than 6000 stimulated cycles. Dr. Najdecki’s vast experience in reproductive gynaecology and embryology has contributed greatly to his achievements in the field, e.g. the second baby birth through IVF technique in Poland and the first transvaginal, ultrasound OPU (oocyte retrieval), which resulted in second IVF baby being born in the nation. These successes opened new doors to a new era in IVF techniques that continues till now. Assisting Nature IVF clinic provides international couples who are struggling to conceive with the most advanced donor egg programs in Greece.
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Caroline Kulczycka

Caroline Kulczycka

Caroline Kulczycka is managing MyIVFAnswers.com and has been hosting IVFWEBINARS dedicated to patients struggling with infertility since 2020. She's highly motivated and believes that educating patients so that they can make informed decisions is essential in their IVF journey. In the past, she has been working as an International Patient Coordinator, where she was helping and directing patients on their right path. She also worked in the tourism industry, and dealt with international customers on a daily basis, including working abroad. In her free time, you’ll find her travelling, biking, learning new things, or spending time outdoors.
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