Role of Hysteroscopy in Patients with Previous In Vitro Fertilization Failure: An Institutional Experience in Rural Population

Pounikar, Minakshi; Shrivastava, Deepti; Sharma, Sreevalli; Tadghare, Jitendra

doi:10.1007/s13224-022-01729-5

Cited by 2 publications

(4 citation statements)

References 20 publications

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“…Of these, 46 articles were excluded for various reasons: 25 were non-RCTs, 20 did not meet our inclusion criteria, such as lacking a control group design, including patients with natural pregnancy or including patients undergoing intrauterine insemination, 10 did not report the outcomes of interest, 21 were not in English, and one were inaccessible in full text. Although three articles did not provide data on the primary outcome of live birth rate, they were included in this meta-analysis due to their reporting of other relevant secondary outcomes [ 14 – 16 ]. Ultimately, 10 RCTs were incorporated into this meta-analysis [ 17 – 23 ].…”

Section: Resultsmentioning

confidence: 99%

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Outpatient hysteroscopy impact on subsequent assisted reproductive technology: a systematic review and meta-analysis in patients with normal transvaginal sonography or hysterosalpingography images

Hou,

Lu,

Huang

et al. 2024

Reprod Biol Endocrinol

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Background Standard management for intrauterine lesions typically involves initial imaging followed by operative hysteroscopy for suspicious findings. However, the efficacy of routine outpatient hysteroscopy in women undergoing assisted reproductive technology (ART) remains uncertain due to a lack of decisive high-quality evidence. This study aimed to determine whether outpatient hysteroscopy is beneficial for infertile women who have unremarkable imaging results prior to undergoing ART. Methods A systematic review and meta-analysis were conducted following PRISMA guidelines, incorporating data up to May 31, 2023, from databases such as PubMed, Embase, and the Cochrane Library. The primary outcome assessed was the live birth rate, with secondary outcomes including chemical pregnancy, clinical pregnancy rates, and miscarriage rates. Statistical analysis involved calculating risk ratios with 95% confidence intervals and assessing heterogeneity with the I2 statistic. Results The analysis included ten randomized control trials. Receiving outpatient hysteroscopy before undergoing ART was associated with increased live birth (RR 1.22, 95% CI 1.03–1.45, I2 61%) and clinical pregnancy rate (RR 1.27 95% CI 1.10–1.47, I2 53%). Miscarriage rates did not differ significantly (RR 1.25, CI 0.90–1.76, I2 50%). Subgroup analyses did not show a significant difference in clinical pregnancy rates when comparing normal versus abnormal hysteroscopic findings (RR 1.01, CI 0.78–1.32, I2 38%). We analyzed data using both intention-to-treat and per-protocol approaches, and our findings were consistent across both analytical methods. Conclusions Office hysteroscopy may enhance live birth and clinical pregnancy rates in infertile women undergoing ART, even when previous imaging studies show no apparent intrauterine lesions. Treating lesions not detected by imaging may improve ART outcomes. The most commonly missed lesions are endometrial polyps, submucosal fibroids and endometritis, which are all known to affect ART success rates. The findings suggested that hysteroscopy, given its diagnostic accuracy and patient tolerability, should be considered in the management of infertility. Database registration The study was registered in the International Prospective Register of Systemic Review database (CRD42023476403).

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Section: Resultsmentioning

confidence: 99%

“…Nonetheless, this study has limitations. The quality of the included RCTs varied, with some being small-scale and having bias concerns, including one study with a high risk of bias [ 14 ]. Sensitivity analyses, excluding the study with high risk, did not alter our results.…”

Section: Discussionmentioning

confidence: 99%

Outpatient hysteroscopy impact on subsequent assisted reproductive technology: a systematic review and meta-analysis in patients with normal transvaginal sonography or hysterosalpingography images

Hou,

Lu,

Huang

et al. 2024

Reprod Biol Endocrinol

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“…Значительное влияние на эффективность протоколов ЭКО было выявлено при сравнении группы пациенток после гистероскопии с группой контроля, причем в обеих группах не было выявлено патологических изменений при ультразвуковом исследовании и гистеросальпингографии [9,16]. В новом аналогичном исследовании с обновленными критериями показатель частоты клинических беременностей оказался также выше у пациенток с предварительно проведенной гистероскопией [17].…”

Section: Discussionunclassified

“…Схожие результаты получены в метаанализах за 2019 и 2020 гг., однако сведения о частоте выкидышей и живорождений в этих обзорах противоречат друг другу [18,19]. В рамках ряда работ выявлена статистически значимая связь между повышением вероятности имплантации плодного яйца и формированием клинической беременности с фактом лечебного повреждения эндометрия в рамках программы подготовки к ЭКО [16,17,[21][22][23][24][25]. Проведение же диагностической гистероскопии изолированно, без лечебного повреждения эндометрия, не сказывалось на эффективности протоколов ЭКО [26].…”

Section: Discussionunclassified

Hysteroscopy with Endometrial Vacuum Aspiration in Repeated Implantation Failure: Diagnostic Significance and the Effect on IVF Success

Kuznetsov,

Opatovskaya,

Askerova

et al. 2024

Урал. мед. журнал

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Introduction. This study raises the issue of diagnostic and therapeutic value of hysteroscopy with endometrial vacuum aspiration in patients with recurrent implantation failure (RIF) in IVF programs.The purpose of the study is to determine the structure of uterine pathology in women with RIF according to hysteroscopy with endometrial aspiration biopsy and to study the eﬀect of hysteroscopy with subsequent endometrial vacuum aspiration in patients with a history of repeated implantation failures on clinical pregnancy rate.Materials and methods. In this retrospective cohort study we investigated a sample of 143 patients who passed the program of IVF at the Clinical Institute of Reproductive Medicine (Ekaterinburg, Russia). We studied the frequency of detection of uterine pathology using hysteroscopy and endometrial vacuum aspiration in patients with RIF (n = 36) and in the control group without RIF (n = 89). We analyzed the diﬀerences in the chance of clinical pregnancy aﬅer embryo transfer (s) in the IVF program in patients with RIF aﬅer hysteroscopy with endometrial vacuum aspiration (n = 30) and in the control group (n = 18).Results. The structure of intrauterine pathology was not statistically diﬀerent in patients with RIF and without this condition (p > 0.05 for all pathologies). Hysteroscopy with endometrial vacuum aspiration signiﬁcantly increased the incidence of clinical pregnancies in patients with RIF compared with the control group (23/30 (77.0 %) and 8/18 (44.0 %), p = 0.032).Discussion. The obtained data on the structure of the pathology of the uterus correlate with the results of similar studies. The therapeutic eﬀect of hysteroscopy in infertility remains a matter of controversy.Conclusion. Hysteroscopy with pathomorphological examination of the aspirated endometrium is the same intervention in terms of diagnostic eﬃciency for patients without identiﬁed uterine pathology on ultrasound, regardless of RIF status. Hysteroscopic examination with curative endometrial injury may increase the success rate of embryo transfer implants in patients with RIF.

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Role of Hysteroscopy in Patients with Previous In Vitro Fertilization Failure: An Institutional Experience in Rural Population

Cited by 2 publications

References 20 publications

Outpatient hysteroscopy impact on subsequent assisted reproductive technology: a systematic review and meta-analysis in patients with normal transvaginal sonography or hysterosalpingography images

Outpatient hysteroscopy impact on subsequent assisted reproductive technology: a systematic review and meta-analysis in patients with normal transvaginal sonography or hysterosalpingography images

Hysteroscopy with Endometrial Vacuum Aspiration in Repeated Implantation Failure: Diagnostic Significance and the Effect on IVF Success

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