Is Hysteroscopy Prior to IVF Associated with an Increased Probability of Live Births in Patients with Normal Transvaginal Scan Findings after Their First Failed IVF Trial?

Abstract

(1) Background: Nowadays, pregnancy can be achieved by in vitro fertilisation (IVF) or by intracytoplasmic sperm injection (ICSI) for many infertile couples. However, implantation failure still remains a significant problem and it can be stressful for both patients and doctors. One of the key players for pregnancy achievement is the uterine environment. Hysteroscopy is the most reliable method to evaluate the uterine cavity and to identify any intauterine pathology. The aim of this retrospective study was to compare live birth ranges in between women who after a first failed IVF/ICSI attempt underwent a hysteroscopy and those who were evaluated by a transvaginal scan. (2) The retrospective study took place at the Assisted Reproductive Unit of the University Hospital of Ioannina, Greece, from 2017 to 2020. It included 334 women with normal findings in a repeat ultrasound scan after a failed IVF/ICSI trial, 137 of whom underwent in turn diagnostic hysteroscopy before the next IVF/ICSI. (3) Results: Live birth rates were higher in the study group (58/137 vs. 52/197 p = 0.0025). Abnormal endometrial findings were identified in 30% of the patients of the study group. (4) Conclusions: The addition of hysteroscopy as an additional investigation to those patients with a first failed IVF/ICSI could improve the rates of live births. A properly conducted RCT could lead to a robust answer.

Endometrial thickness: How thin is too thin?

“…The use of diagnostic hysteroscopy before IVF to enhance uterine receptivity is controversial; yet, many IVF clinics in the United States perform some form of uterine cavity evaluation before the first IVF cycle (including saline infusion sonogram or office hysteroscopy). There is mixed evidence supporting the use of routine hysteroscopy to improve IVF outcomes in asymptomatic women (56)(57)(58). Interestingly, abnormal endometrial pathology has been estimated to be identified in approximately 18%-30% of patients with a history of a failed IVF cycle despite a normal transvaginal ultrasound result (57)(58)(59).…”

“…There is mixed evidence supporting the use of routine hysteroscopy to improve IVF outcomes in asymptomatic women (56)(57)(58). Interestingly, abnormal endometrial pathology has been estimated to be identified in approximately 18%-30% of patients with a history of a failed IVF cycle despite a normal transvaginal ultrasound result (57)(58)(59). However, whether the surgical removal of all uterine pathologies (i.e., subcentimeter polyps or filmy intrauterine adhesions) improves IVF and embryo transfer outcomes remains controversial (60).…”

Updates in Assisted Reproduction

“…In the current Special Issue “Updates in assisted reproduction treatment”, three important papers have been published so far, addressing the following topics: the role of hysteroscopy prior to an in vitro fertilization (IVF) cycle [ 1 ], the type of anesthesia applied during oocyte retrieval [ 2 ], and a pre-embryo transfer endometrial procedure in frozen cycles [ 3 ]. The results of these papers, though somewhat different from existing notions, provide an additive character to the past literature that is of great interest.…”