Office hysteroscopy before first in vitro fertilization. A randomized controlled trial

Abid, Haifa Ben; Fékih, M.; Fathallah, Khadija; Chachia, Salma; Bibi, M.; Khaïri, H.

doi:10.1016/j.jogoh.2021.102109

Cited by 13 publications

(11 citation statements)

References 15 publications

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“…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: Study Selectionmentioning

confidence: 99%

Section: Types Of Patients and Interventions Comparisonmentioning

confidence: 99%

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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“…A recent RCT assessed the role of office hysteroscopy prior to the first ART cycle and the authors reported that the office hysteroscopy did not improve ART results. Minimal intrauterine anomalies not diagnosed by transvaginal US or hysterosalpingography do not seem to negatively affect ART outcomes ( Ben Abid et al , 2021 ). On the other hand, there is low-quality evidence that operative hysteroscopy increases the pregnancy rate in infertile women with previously diagnosed polyps ( Di Spiezio Sardo et al , 2016 ).…”

Section: Recommendationsmentioning

confidence: 99%

Evidence and consensus on technical aspects of embryo transfer

D’Angelo

Panayotidis²,

Alteri

et al. 2022

Human Reproduction Open

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BACKGROUND Ultrasound-guided embryo transfer (US-GET) is a widely performed procedure, but standards for the best practice are not available. OBJECTIVE AND RATIONALE This document aims to provide an overview of technical aspects of US-GET after considering the published data and including the preparation for the embryo transfer (ET) procedure, the actual procedure, the post-procedure care, associated pathologies, complications and risks, quality assurance and practitioners’ performance. SEARCH METHODS A literature search for evidence on key aspects of the ET procedure was carried out from database inception to November 2021. Selected papers (n = 359) relevant to the topic were analysed by the authors. The following key points were considered in the papers: whether ultrasound (US) practice standards were explained, to what extent the ET technique was described and whether complications or incidents and how to prevent such events were reported. In the end, 89 papers could be used to support the recommendations in this document, which focused on transabdominal US-GET. OUTCOMES The relevant papers found in the literature search were included in the current document and described according to the topic in three main sections: requirements and preparations prior to ET, the ET procedure, and training and competence for ET. Recommendations are provided on preparations prior to ET, equipment and materials, ET technique, possible risks and complications, training and competence. Specific aspects of the laboratory procedures are covered, in particular the different loading techniques and their potential impact on the final outcomes. Potential future developments and research priorities regarding the ET technique are also outlined. LIMITATIONS, REASONS FOR CAUTION Many topics were not covered in the literature review and some recommendations were based on expert opinions and are not necessarily evidence based. WIDER IMPLICATIONS ET is the last procedural step in an ART treatment and is a crucial step toward achieving a pregnancy and live birth. The current paper set out to bring together the recent developments considering all aspects of ET, especially emphasizing US quality imaging. There are still many questions needing answers, and these can be subject of future research. STUDY FUNDING/COMPETING INTEREST(S) No funding. ADA has received royalties from CRC Press and personal honorarium from Cook, Ferring and Cooper Surgical. The other co-authors have no conflicts of interest to declare that are relevant to the content of this article.

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“…5 There are still no clear recommendations on whether CE needs to be screened before ART in the initial assessment of infertile couples, especially when a transvaginal ultrasound before the first in vitro fertilization (IVF) treatment reveals no problems. 6,7 Hysteroscopy screening in patients with non-uniform endometrial echogenicity is likely warrented. 8 Though the clinical meaning of non-uniform endometrial echogenicity without intracavitary lesions remains uncertain, it is unclear whether the incidence of CE is significantly elevated patients with non-uniform endometrial echogenicity, especially among women with infertility.…”

Section: Introductionmentioning

confidence: 99%

“…There are still no clear recommendations on whether CE needs to be screened before ART in the initial assessment of infertile couples, especially when a transvaginal ultrasound before the first in vitro fertilization (IVF) treatment reveals no problems 6,7 . Hysteroscopy screening in patients with non‐uniform endometrial echogenicity is likely warrented 8 .…”

Section: Introductionmentioning

confidence: 99%

High prevalence of chronic endometritis is associated with metabolic abnormality and reduced live birth rate among IVF women with non‐uniform endometrial echogenicity

Guo,

Li,

Liu

et al. 2023

American J Rep Immunol

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ObjectiveTo assess the prevalence of chronic endometritis (CE) among women with non‐uniform endometrial echogenicity, and to evaluate the association between CE and metabolic characteristics as well as pregnancy outcomes in the subsequent frozen–thawed embryo transfer (FET) cycles.DesignRetrospective cohort study.SettingUniversity‐based hospitals and an academic medical center.PatientsA total of 315 patients included in this research underwent hysteroscopy and endometrial biopsy before the first FET cycle after whole embryos freezing. Patients were divided into CE (histopathologic CE or hysteroscopic CE) and non‐CE groups.Intervention(s)Freeze‐all strategy, hysteroscopy and endometrial biopsy.Main Outcome MeasuresBaseline and cycle characteristics, hysteroscopic, and histopathological profile, as well as pregnancy outcomes.ResultsThe prevalence of histopathologic CE and hysteroscopic CE were 78.1% and 34.9%, respectively. CE was associated with higher homocysteine level and BMI, independent of insulin response and dyslipidemia. High homocysteine level and BMI were risk factors for histopathologic CE (OR: 1.182; 95% CI: 1.01–1.384; p = .037) and hysteroscopic CE (OR: 1.117; 95% CI: 1.041–1.199; p = .002), respectively. Histopathologic CE was a risk factor for live birth (OR:2.167; 95% CI: 1.037–4.525; p = .04), and hysteroscopic CE was an independent risk factor for both live birth (OR: 4.239; 95% CI: 1.929–9.313; p = .001) and cumulative live birth (OR: 3.963; 95% CI: 1.875–8.376; p = .001).ConclusionsInfertile women with non‐uniform endometrial echogenicity have a high prevalence of CE which significantly reduces the live birth rate. Diagnosing CE by hysteroscopy is important to assess the cumulative probability of pregnancy in IVF patients.

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Office hysteroscopy before first in vitro fertilization. A randomized controlled trial

Cited by 13 publications

References 15 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

Evidence and consensus on technical aspects of embryo transfer

High prevalence of chronic endometritis is associated with metabolic abnormality and reduced live birth rate among IVF women with non‐uniform endometrial echogenicity

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