The role of hysteroscopy before intracytoplasmic sperm injection (ICSI): a randomized controlled trial

Elnashar, I.; Nasr, Ahmed

doi:10.1016/j.fertnstert.2011.07.1016

Cited by 13 publications

(6 citation statements)

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“…Due to multiple retractions and expression of concerns for the data acquisition, one paper was considered with overall high risk of bias and was excluded from quantitative synthesis and meta-analysis [ 29 ]. Due to an unsatisfactory approach to random sequence generation, three studies [ 21 , 23 , 31 ] exhibited a significant risk of selection bias. As the randomization procedure was not disclosed, the same three trials were determined to have an uncertain risk of bias (online suppl.…”

Section: Resultsmentioning

confidence: 99%

“…There were none or very few dropouts reported in the included studies, the groups were balanced, and the reasons for dropouts were always disclosed. All studies, except three [ 21 , 23 , 31 ], were deemed to be at low risk of attrition bias. Because no data were provided for several outcomes, Moramezi et al, Aghahosseini et al, and El-Nashar and Nasr [ 21 , 23 , 31 ] were classified as having an unclear risk of attrition bias (online suppl.…”

Section: Resultsmentioning

confidence: 99%

“…Eighteen studies were assessed for full text, of which 2 were removed for being out of topic or not providing the outcome of interest. Sixteen studies were included in qualitative synthesis [11][12][13][20][21][22][23][24][25][26][27][28][29][30][31][32]. Subsequently, one study was removed due to multiple retractions for the first author of the research [29] (Fig.…”

Section: Study Selectionmentioning

confidence: 99%

“…The authors compared women undergoing polyp biopsy and diagnostic hysteroscopy only with patients undergoing hysteroscopic polypectomy. Women who were candidates for their first IVF attempt were included in seven trials [11,23,26,27,[29][30][31]. Five studies included infertile women with one or more failed IVF cycles and unsuspected or no uterine cavity abnormalities [12,21,22,24,32].…”

Section: Types Of Patients and Interventions Comparisonmentioning

confidence: 99%

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Efficacy of Hysteroscopy in Improving Fertility Outcomes in Women Undergoing Assisted Reproductive Technique: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Vitale,

Angioni,

Parry

et al. 2023

Gynecol Obstet Invest

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Introduction: Usefulness of hysteroscopy before assisted reproductive technique (ART) was considered debatable. However, over the last decade, several new trials were added to available literature. We aimed to assess the impact of diagnostic and operative hysteroscopy on reproductive outcomes of infertile women with and without intrauterine abnormalities. Materials and Methods: MEDLINE, Scopus, Scielo, EMBASE, Cochrane Library at CENTRAL, PROSPERO, CINAHL, grey literature, conference proceedings, and international controlled trials registries were searched without temporal, geographical, or language restrictions. Randomized controlled trials (RCTs) of infertile women comparing hysteroscopy versus no hysteroscopy prior to the first ART or after at least one failed attempt were included. RCTs of infertile women with intrauterine pathology comparing diagnostic vs operative hysteroscopy were included in separate analysis. Random-effect meta-analysis was conducted according to PRISMA guidelines. GRADE and Cochrane criteria were used for quality of evidence and risk of bias assessment. Primary outcome was live birth rate (LBR). Secondary outcomes were clinical pregnancy (CPR) and pregnancy loss rate (PLR). Results: Fifteen studies (5038 women) were included. Compared to no hysteroscopy before first or after failed ART attempts, moderate quality evidence showed that hysteroscopy increased the LBR (relative risk (RR) 1.24, 95% confidence interval (CI) 1.09-1.43, I2=21%), confirmed by subgroup analysis for women with failure after one or more ART cycles (RR 1.43, 95% CI 1.19– 1.72, I2=0%) but not before the first ART. Moderate quality evidence showed that it increased the CPR (RR 1.36, 95% CI 1.18–1.57; I2=51%), confirmed in subgroup analysis for both implantation failure (RR 1.40, 95% CI 1.12–1.74, I2=52%) and before first ART (RR 1.32, 95% CI 1.11–1.57, I2=42%). Low-quality data suggest that operative hysteroscopy increases CPR when used to treat intrauterine pathologies (RR 2.13, 95% CI 1.56 – 2.92, I2=0%). Conclusions: Although moderate quality evidence supports performing hysteroscopy before ART in women with history of implantation failure, hysteroscopic evaluation of uterine cavity should be considered a first-line technique in all infertile women undergoing ART. Additional high-quality RCTs are still needed, particularly to assess yield during couple’s initial evaluation even before ART is considered. PROSPERO Registration number: CRD42023363344

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Study Selectionmentioning

confidence: 99%

Section: Types Of Patients and Interventions Comparisonmentioning

confidence: 99%

See 2 more Smart Citations

Efficacy of Hysteroscopy in Improving Fertility Outcomes in Women Undergoing Assisted Reproductive Technique: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Vitale,

Angioni,

Parry

et al. 2023

Gynecol Obstet Invest

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“…Ten studies were retrieved including 1,836 women in the intervention group (screening hysteroscopy) and 1,914 women in the comparator (no hysteroscopy) bound to undergo IVF/ ICSI. [36][37][38][39][40][41][42][43][44][45] No RCTs were found in women bound to be treated with IUI. In 8 of the 10 studies, there were some concerns about risk of bias arising from the randomization process (unclear allocation concealment).…”

Section: Women Bound To Be Treated With Iui or Ivf/icsimentioning

confidence: 99%

Does Laparoscopy and Hysteroscopy Have a Place in the Diagnosis of Unexplained Infertility?

2020

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The standard fertility workup includes assessment of ovulation, semen analysis, and evaluation of tubal patency. If the fertility workup is found to be normal, a diagnosis of unexplained infertility is made. The role of laparoscopy in fertility workup has been a matter of debate. The current review presents the evidence for and against laparoscopy and hysteroscopy during fertility workup and subsequently prior to fertility treatment. After appraising the literature, we found the role of diagnostic laparoscopy in fertility workup is limited and is dependent on factors like prevalence of pelvic infection, setting, and availability of expertise. Moreover, whenever a laparoscopy is planned as a part of the fertility workup, the preparation should include ability to carry out simultaneous therapeutic intervention to maximize the benefit. Similarly, the routine use of hysteroscopy in women with unexplained infertility cannot be recommended. There is a need to investigate the impact of choice of tubal test on chances of spontaneous conception and treatment outcomes in women with unexplained infertility. Our future research agenda should also include high-quality multicenter randomized trials assessing the cost-effectiveness of screening and operative hysteroscopy prior to intrauterine insemination or in vitro fertilization.

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Hysteroscopy for treating subfertility associated with suspected major uterine cavity abnormalities

Bosteels¹,

Kasius

Weyers

et al. 2013

Cochrane Database of Systematic Reviews

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Background Observational studies suggest higher pregnancy rates after the hysteroscopic removal of endometrial polyps, submucous fibroids, uterine septum or intrauterine adhesions, which are detectable in 10% to 15% of women seeking treatment for subfertility. Objectives To assess the effects of the hysteroscopic removal of endometrial polyps, submucous fibroids, uterine septum or intrauterine adhesions suspected on ultrasound, hysterosalpingography, diagnostic hysteroscopy or any combination of these methods in women with otherwise unexplained subfertility or prior to intrauterine insemination (IUI), in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI).

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The role of hysteroscopy before intracytoplasmic sperm injection (ICSI): a randomized controlled trial

Cited by 13 publications

References 0 publications

Efficacy of Hysteroscopy in Improving Fertility Outcomes in Women Undergoing Assisted Reproductive Technique: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Efficacy of Hysteroscopy in Improving Fertility Outcomes in Women Undergoing Assisted Reproductive Technique: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Does Laparoscopy and Hysteroscopy Have a Place in the Diagnosis of Unexplained Infertility?

Hysteroscopy for treating subfertility associated with suspected major uterine cavity abnormalities

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