Office hysteroscopy before first in vitro fertilization. A randomized controlled trial

Area of Science:

• Reproductive Medicine
• Infertility Research
• Gynecologic Surgery

Background:

• Implantation failure in in vitro fertilization (IVF) is a persistent challenge.
• A normal uterine cavity is crucial for successful embryo implantation.
• While hysteroscopy is the gold standard for diagnosing intra-uterine anomalies, its routine use before the first IVF, following normal transvaginal ultrasound (TVUS) and hysterosalpingography (HSG), is not clearly established.

Purpose of the Study:

• To evaluate the effectiveness of office hysteroscopy in improving IVF outcomes when no intra-uterine anomalies are suspected.
• To determine if routine pre-IVF hysteroscopy offers benefits over immediate IVF after normal conventional imaging.

Main Methods:

• A randomized controlled trial was conducted with 171 women undergoing their first IVF.
• Participants were randomized into two groups: Group I (office hysteroscopy before IVF) and Group II (immediate IVF).
• Inclusion criteria included age <40, regular cycles, FSH <10 IU/l, antral follicular count ≥12, normal TVUS/HSG, and BMI 19-30 kg/m²; severe endometriosis, PCOS, and oocyte recipients were excluded.

Main Results:

• No statistically significant difference in live birth rate (23.9% vs. 19.3%) or clinical pregnancy rate (32.4% vs. 21.7%) was observed between the hysteroscopy and immediate IVF groups.
• Office hysteroscopy identified unsuspected intra-uterine anomalies in 30% of cases, including adhesions, polyps, and endometritis, though only a minority required operative intervention.
• Patient-reported discomfort during diagnostic hysteroscopy was minimal, with no major complications.

Conclusions:

• Performing routine office hysteroscopy before the first IVF cycle does not appear to enhance pregnancy or live birth rates.
• Minimal intra-uterine anomalies, undetectable by TVUS and HSG, may not significantly affect IVF success rates.
• The findings suggest that hysteroscopy may not be necessary as a routine procedure before the initial IVF attempt in selected patient populations.