Does hysteroscopy surgery enhance subsequent reproductive outcomes in women with unexplained infertility?

Abstract

Introduction and Aim: Embryo implantation and a healthy placenta depend on the uterine cavity and endometrium, thus any reproductive surgery for unexplained infertility must evaluate these. Hysteroscopy cures intrauterine adhesions, submucous fibroids, endometrial polyps, and endometriosis and directly visualizes the uterus cavity. This study investigated whether hysteroscopy could diagnose uterine disorders in women with recurrent, unexplained miscarriages and improve reproductive outcomes.
 
 Methods: This observational retrospective study included 58 patients who had recurrent pregnancy loss and were hospitalized in the Kamal AL-Samarrai Hospital's reproduction unit / Physiopathology section in Baghdad, Iraq between January 2021 and February 2022. The participants were divided into two groups based on whether they had received hysteroscopic surgery. IVF was performed on patients who underwent hysteroscopy surgery. A comparative analysis was made for clinical factors and uterine pathology among the two groups. Data were subjected to statistical analysis.
 
 Results: The patients in this study ranged in age from 20 to 42 years, with an average of 3265 years, and a BMI ranging from (20-39) with an average of 29.270.48 kg/m2. Out of the 58 women analyzed, 31 (53.4%), 13 (22.4%), and 48 (82.7%) had a previous cesarean, laparoscopy, and HSG procedures, respectively. 28 patients (48.2%) who underwent hysteroscopic surgery were detected with uterine disorders; IUA (28%), fibroids (25%), submucosal polyps (21.4%), endometrial hyperplasia (17.8%), and endometriosis (7.1%). No significant difference was seen for the duration of infertility, type of infertility, or previous IVF attempt failure between the hysteroscopic and control groups (p>0.05). In women who underwent IVF procedures after hysteroscopic surgery, the clinical pregnancy rate was lower as compared to women without surgery.
 Conclusion: Hysteroscopy can diagnose some intrauterine diseases early enough for surgery. Undiagnosed infertility in women with RPL suggests a hysteroscopic examination before in vitro fertilization.