ULTRASOUND IN THE ETIOLOGICAL ASSESSMENT OF EMBRYONIC IMPLANTATION FAILURES AT THE FERTILIA MEDICAL CLINIC IN BAMAKO

Recurrent implantation failure refers to failure to achieve a clinical pregnancy after the transfer of at least four embryos in at least three fresh or frozen cycles in a woman under 40 years of age. Implantation failure can be a consequence of embryonic or uterine factors. Thorough investigations must be necessary to determine whether there is an embryonic or uterine cause. Various uterine pathologies, including fibroids, endometrial lesions, polyps, congenital anomalies and intrauterine adhesions, vascular parameters should be explored by ultrasound to aid in the diagnosis of the causes of embryo implantation failures [1]. Aims: - To describe the sonographic lesions likely to explain embryo implantation failures. - To determine the correlation between ultrasound lesions detected during our study and embryo implantation failures. Subjects And Methods: This was a cross-sectional, descriptive study concerning 165 women collected between January 2016 and January 2022 at the Fertilia medical clinic in Bamako. The study population consisted of consenting women in whom at least three unsuccessful attempts to transfer good quality fresh or frozen embryos were made. All of our patients underwent a biological assessment, but our study focused on the contribution of ultrasound. Ultrasounds were performed by endocavitary and suprapubic route with General Electric Voluson E8, Vivid 3 and Logic9 devices. Results: 165 women were recruited into our. The average age was 38 years with extremes ranging from 23 to 52 years. 86 patients or 52% were between 30 and 40 years old. 94 patients or 57% had made at least three unsuccessful attempts to transfer good quality embryos. 139 patients or 84.24% had at least one ultrasound anomaly. The most common pathologies were adenomyosis (30.3%), endometritis (13.94%), hydrosalpinx (4.24%), a high pulsatility index (12.12%), the presence of notch in one or both uterine arteries (7.27 %), polymyomatous uterus (26%), congenital malformation (1.21%), polyp (4.85%). Conclusion: Repeated embryo implantation failures are partly due to the embryo and partly to the uterus or its annexes. Ultrasound is a tool of choice in developing countries such as ours to diagnose the causes of these implantation failures and to allow infertile couples to procreate. We were able to highlight the relationships that exist between abnormalities detected on ultrasound and repeated embryo implantation failures.