Hysteroscopy: The Uterine Stethoscope Decoding Implantation Failures

To offer or not to offer hysteroscopy has remained an important question among clinicians treating infertility. With this question, we studied the impact of hysteroscopic diagnosis and treatment of pathologies in terms of improvement in implantation rates in patients requiring in vitro fertilization (IVF) treatment at our center.

We performed a retrospective analysis of 432 infertile patients who underwent hysteroscopy prior to embryo transfer (ET) between January 2016 and December 2023: Group 1: patients with previous IVF failure and Group 2: patients without previous IVF failure. Chi-square test of independence was used to check if the relationship found in the contingency table is significant or not as 5% level of significance.

A significant number of participants in Group 1 and Group 2, 70.5% (n = 98 of 139) and 79.9% (n = 234 of 293), respectively (P < 0.0031), were diagnosed and treated for some intrauterine pathology, suggesting their significant role in causing infertility. 51.1% (n = 71 of 139) and 63.1% (n = 185 of 293) patients in Group 1 and Group 2, respectively, were diagnosed with endometritis, showing that there is a significant role of performing hysteroscopy even without an obvious indication of intrauterine pathology diagnosed on ultrasound (P < 0.017).

Although Cochrane review suggests a low level of evidence to support screening hysteroscopy prior to IVF, the results of our study direct us to offer hysteroscopy, preferably to all women planned for IVF-ET cycle irrespective of the ultrasound findings and especially to the patients who have experienced IVF Failure in previous cycles.