Hysterosalpingography prior to the gonadotropin stimulated intrauterine insemination improvesclinical pregnancy rates in women with unexplained infertility

Çağlayan, Emel Kıyak; Okyay, Emre; Bodur, Taylan; Ertugrul, C.; Koyun, Elvan; Kovalı, Müge; Dogan, Erbil; Gülekli, Bülent

doi:10.12891/ceog3217.2017

Cited by 2 publications

(1 citation statement)

References 17 publications

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“…The fluid infusion and irrigation during hysteroscopy could mechanically cleanse the endometrium, potentially eliminating anti-adhesive glycoproteins and fostering a more implantation-conducive environment [ 36 , 37 ]. Increased pregnancy and live birth rates after hysterosalpingography have been documented [ 38 , 39 ], likely due to uterine flushing, which removes tubal debris and modulates macrophage secretion of interleukins and prostaglandins [ 40 – 42 ]. While hysteroscopy employs a gentler flushing force and utilizes fluid instead of contrast media, its pregnancy rate improvement may share a similar mechanism with HSG.…”

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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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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