Uterine Cavity Irrigation With Office Hysteroscopy During Ovarian Stimulation for IVF: A Randomized Controlled Trial

Abstract

ObjectiveThis was a non-blinded randomized controlled study to evaluate whether endometrial irrigation via office hysteroscopy during the early follicular phase would lead to a higher level of live birth rates compared to no irrigation in the fresh embryo transfer cycle.MethodThe study was conducted in Tehran university of medical sciences from June 2015 to June 2016. women under the age of 40 with primary infertility without history of previous IVF/ICSI or hysteroscopic examination, were included. Controlled ovarian hyperstimulation was done. Hysteroscopy was performed in the early mid-follicular phase of a stimulation cycle (day 5-7) with a vaginoscopy approach and saline irrigation in hysteroscopy group. Embryo-transfer was done in the same cycle.Results228 patients completed their participation in the study. In the fresh cycle, clinical pregnancy rate was 46% in the hysteroscopy group and 40.43% in the control group. (p-value= 0.326, RR= 1.16 [95%CI: 0.862 to 1.56]). Live birth rate was 41.28% in the hysteroscopic group and 31.93% in the control group (p-value=0.143, RR= 1.293 [95%CI: 0.916 to 1.825]). For those patients having surplus cryopreserved embryos, after 2 months, a second embryo transfer was performed. The cumulative LBR was 44.05% in the hysteroscopic group and 32.25% in the control group (p-value=0.029, RR= 1.368 [95%CI: 1.031 to 1.815], RD= 11.9% [95%CI: 1.2% to 22.3%] and NNT= 8 [95%CI: 4 to 85]).ConclusionThe current study clearly demonstrated a significantly higher cumulative live birth rate in the intervention group.Clinical Trial Registration[https://www.irct.ir/trial/19586], identifier IRCT2016011022795N2.

Efficacy of Hysteroscopy in Improving Fertility Outcomes in Women Undergoing Assisted Reproductive Technique: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…Comparison 1: nine studies [ 12 , 13 , 21 , 24 , 26 – 28 , 30 , 32 ], including 3,344 women, evaluated the LBR between the hysteroscopy versus no-hysteroscopy groups in the infertility workup. Overall, we found a significantly higher LBR in women undergoing hysteroscopy (RR 1.24; 95% CI: 1.09–1.43, I 2 = 21%) ( Fig.…”

“…Comparison 1: twelve RCTs with 4,782 women were included [ 11 – 13 , 21 – 24 , 26 , 27 , 30 – 32 ]. The overall results showed improved CPRs with hysteroscopy (RR 1.36, 95% CI: 1.18–1.58, I 2 = 54%).…”

“…There is speculation about the potential advantage of performing a diagnostic hysteroscopy with copious irrigation of the uterine cavity before ART [ 26 ]. First, irrigation could physically remove damaging anti-adhesive glycoproteins from the surface of the endometrium which enhance endometrial receptivity.…”

“…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.…”

“…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].…”