Hysteroscopy before in-vitro fertilisation (inSIGHT): a multicentre, randomised controlled trial

Area of Science:

• Reproductive Medicine
• Gynecologic Surgery
• Clinical Trials

Background:

• Hysteroscopy is frequently performed in infertile women undergoing in-vitro fertilisation (IVF) to enhance pregnancy success.
• However, robust evidence from randomised controlled trials (RCTs) supporting this practice is lacking.
• The study aimed to evaluate the efficacy of routine hysteroscopy prior to the first IVF cycle on livebirth rates.

Purpose of the Study:

• To determine if routine hysteroscopy before the first in-vitro fertilisation (IVF) treatment cycle increases the rate of livebirths.
• To provide evidence-based recommendations for the management of infertile women with normal transvaginal ultrasound findings before IVF.

Main Methods:

• A pragmatic, multicentre, randomised controlled trial was conducted involving 750 women scheduled for their first IVF treatment.
• Participants with normal transvaginal ultrasound and no prior hysteroscopy were randomised (1:1) to either hysteroscopy with potential treatment or immediate IVF.
• The primary outcome was ongoing pregnancy resulting in livebirth within 18 months, analysed by intention-to-treat.

Main Results:

• No significant difference in livebirth rates was observed between the hysteroscopy group (57%) and the immediate IVF group (54%) (relative risk 1.06, 95% CI 0.93-1.20; p=0.41).
• The incidence of endometritis after hysteroscopy was less than 1% in the hysteroscopy group.
• The trial enrolled 750 women between May 2011 and August 2013.

Conclusions:

• Routine hysteroscopy does not improve livebirth rates in infertile women with normal transvaginal ultrasound findings scheduled for their first IVF treatment.
• These findings suggest that routine hysteroscopy should not be offered to this patient population.
• The study provides crucial evidence to guide clinical practice in assisted reproductive technologies.