Hysteroscopy prior to the first IVF cycle: A systematic review and meta-analysis

Abstract

This systematic review and meta-analysis investigated the use of routine hysteroscopy prior to starting the first IVF cycle on treatment outcome in asymptomatic women. Searches were conducted on MEDLINE, EMBASE, Cochrane Library, National Research Register and ISI Conference Proceedings. The main outcome measures were clinical pregnancy and live birth rates achieved in the index IVF cycle. One randomized and five non-randomized controlled studies including a total of 3179 participants were included comparing hysteroscopy with no intervention in the cycle preceding the first IVF cycle. There was a significantly higher clinical pregnancy rate (relative risk, RR, 1.44, 95% CI 1.08-1.92, P=0.01) and LBR (RR 1.30, 95% CI 1.00-1.67, P=0.05) in the subsequent IVF cycle in the hysteroscopy group. The number needed to treat after hysteroscopy to achieve one additional clinical pregnancy was 10 (95% CI 7-14) and live birth was 11 (95% CI 7-16). Hysteroscopy in asymptomatic woman prior to their first IVF cycle could improve treatment outcome when performed just before commencing the IVF cycle. Robust and high-quality randomized trials to confirm this finding are warranted. Currently, there is evidence that performing hysteroscopy (camera examination of the womb cavity) before starting IVF treatment could increase the chance of pregnancy in the subsequent IVF cycle in women who had one or more failed IVF cycles. However, recommendations regarding the efficacy of routine use of hysteroscopy prior to starting the first IVF treatment cycle are lacking. We reviewed systematically the trials related to the impact of hysteroscopy prior to starting the first IVF cycle on treatment outcomes of pregnancy rate and live birth rate in asymptomatic women. Literature searches were conducted in all major database and all randomized and non-randomized controlled trials were included in our study (up to March 2013). The main outcome measures were the clinical pregnancy rate and live birth rate. The secondary outcome measure was the procedure related complication rate. A total of 3179 women, of which 1277 had hysteroscopy and 1902 did not have a hysteroscopy prior to first IVF treatment, were included in six controlled studies. Hysteroscopy in asymptomatic woman prior to their first IVF cycle was found to be associated with improved chance of achieving a pregnancy and live birth when performed just before commencing the IVF cycle. The procedure was safe. Larger studies are still required to confirm our findings.

The Value of Routine Hysteroscopy before the First Intracytoplasmic Sperm Injection Treatment Cycle

“…In 2014, Pundir et al [4] did a systematic review on using hysteroscopy before the first IVF cycles. They analyzed 6 randomized controlled studies, that is, a total of 3,179 cases, among which 1,277 did hysteroscopy before doing IVF and 1,902 cases started IVF without hysteroscopy.…”

“…Even mild uterine abnormalities such as mild adhesions, small submucous myomas and endometrial polyps seem to lower the pregnancy rate through in vitro fertilization (IVF) [3] . Abnormal uterine findings are reported in about 50% of women with recurrent implantation failure [4] . Around 25% of infertile patients have an abnormal uterine cavity [5] .…”

Endometrial cancer in a woman undergoing hysteroscopy for recurrent IVF failure

“…Hysteroscopy, for instance, in spite of being the undisputed gold standard for the examination of the uterine cavity, is controversial as a routine procedure [1]. However, growing evidence suggests a unique diagnostic and therapeutic role for hysteroscopy, especially in cases of repeated failures of assisted reproductive technology [2]. In such cases, abnormal hysteroscopic findings, such as endometrial polyps, submucous fibroids, adhesions, and septa, are common [3–5], and hysteroscopy offers an opportunity for diagnosis and a convenient see-and-treat management [2, 6].…”

“…However, growing evidence suggests a unique diagnostic and therapeutic role for hysteroscopy, especially in cases of repeated failures of assisted reproductive technology [2]. In such cases, abnormal hysteroscopic findings, such as endometrial polyps, submucous fibroids, adhesions, and septa, are common [3–5], and hysteroscopy offers an opportunity for diagnosis and a convenient see-and-treat management [2, 6]. Endometrial malignancy, on the contrary, is unreported in large published series [3–5], and its impact on fertility, for obvious reasons, has not been studied.…”

Perinatal outcomes in singleton and twin ICSI pregnancies following hysteroscopic correction of partial intrauterine septa

“…Although surgical technologies have improved greatly, the procedures may still induce unintentional inflammatory reactions, that may affect placentation and, thus, the periimplantation and perinatal outcomes of subsequent conceptions [24,25]. The data from our study shows that some patients who had hysteroscopic surgery for partial intrauterine septa may still be susceptible to a greater risk of fetal loss, possibly due to intrauterine factors that are non-correctable [1,2,5].…”