Routine office hysteroscopy in the investigation of infertile couples before assisted reproduction

To evaluate the need for office hysteroscopy in routine investigations of infertile couples prior to assisted reproduction (AR).

A retrospective and descriptive clinical study of all outpatients who underwent AR infertility investigation from January 1996 to December 2001 at the Ribeirão Preto Hospital das Clínicas. All the patients underwent hysteroscopy.

A total of 574 patients were studied. Normal ultrasonograms were seen in 498 (86.8%). Of the 498, 159 (27.7%) had normal ultrasonograms and no complaints; 50 (8.7%) had normal ultrasonograms and abnormal hysteroscopies. Eight (1.4%) had no complaints, normal ultrasonograms and abnormal hysteroscopies. Twenty-nine (5.1%) of the 50 with abnormal hysteroscopies required treatment prior to AR. No correlation was found between the 2 examination types (kappa = 0.305). Clinical complaints included dysmenorrhea (40%), chronic pelvic pain (21%) and menstrual irregularity (30%). Significant uterine cavity abnormalities were müllerian malformations (30%), endometrial polyps (26.4%) and intrauterine adhesions (16%).

Given the impracticality of performing hysteroscopy on pre-AR patients, diagnostic hysteroscopy should be considered only for those whose clinical complaints imply the presence of endometrial disease or whose ultrasonograms are abnormal.