Hysteroscopy Before in Vitro Fertilization

Abstract

In the last decade, success after in vitro fertilization process (IVF) has remained at a similar rate despite all the improvements implemented in the stimulation protocols and laboratory techniques. Hysteroscopy is a method becoming more widely used with patients after a failed IVF cycle, considering a large incidence of uterus cavum pathological states which have a negative impact on the favorable outcome. Numerous studies have provided different results on the IVF outcome with hysteroscopy performed prior to this treatment in cases with no uterus cavum pathology. The aim of the research was to examine the effect of both diagnostic and surgical hysteroscopy on the outcome of IVF. Hysteroscopy was performed with 74 patients 30 to 50 days prior to IVF and in 33 of them (group I) some pathological state was noticed, which was treated during the same procedure. The control group (group III) included 151 patients who had IVF performed with no prior hysteroscopy. There is no statistically significant difference in the rate of post hysteroscopy implantation between I and II group when compared to the control group (20.62% vs 23.28% vs 17.31%), nor in the rate of clinical pregnancies (45.45% vs 46.34% vs 34.44%). Following the correctional treatment of uterus cavum pathological states, implantation and pregnancy rates remain at a level comparable to hysteroscopically normal medical findings. Statistically significant higher pregnancy rate is present in group I after the first IVF cycle, compared to the next IVF in the same group and in comparison to the next IVF cycle in the control group (60.00% vs 27.91%, p<0.05). Hysteroscopy is a simple and safe method allowing nearly identical rate of clinical pregnancies after a surgical treatment of uterus cavum pathological states when compared to the control group, but statistically much higher pregnancy rate if the order of IVF procedure is being compared. In cases of normal ultrasound findings and negative hysteroscopical findings, performing hysteroscopy prior to IVF does not provide significantly better results. Therefore, its routine execution is not recommended.