Hysteroscopy before the first in vitro fertilization: a 7-year experience from a single center

Abstract

Objective. This study aims to evaluate the importance of performing hysteroscopy prior to the first attempt of in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) by specifying the incidence of intrauterine pathologies and the success of IVF/ICSI cycle. Methods. This is a retrospective review of 357 women who underwent their first cycle of IVF/ICSI treatment during a 7- year period. All women had primary infertility due to various factors: Polycystic ovary syndrome (n=101), male factor (n=84), tubal factor (n=78) and unexplained infertility (n=94). Results. The majority of the patients had normal hysteroscopic findings whereas 29.4% of them had an intrauterine pathology. Abnormal hysteroscopic findings included endometrial polyps (13.7%), submucous myomas (5.9%), uterine septa (4.5%), endometrial adhesions (3.1%), endometritis (1.4%) and cervical stenosis (0.8%). When compared to the women with normal hysteroscopy (n=252), the women with corrected hysteroscopic abnormalities (n=105) had significantly higher fertilization rate (p=0.045), implantation rate (p=0.038), clinical pregnancy rate (p=0.022) and live birth rate (p=0.022). When compared to the women with normal transvaginal ultrasonography and hysteroscopy findings (n=252), the women with normal ultrasonography and abnormal hysteroscopy (n=35) had significantly higher implantation rate (p=0.044), clinical pregnancy rate (p=0.032) and live birth rate (p=0.030). Conclusion: The utilization of hysteroscopy before the first IVF cycle would allow the detection and treatment of intrauterine pathologies and structural uterine abnormalities that might be responsible for the failure of IVF and, thus, result in improved pregnancy rates.