What Is the Role of Hysteroscopic Surgery in the Management of Female Infertility? A Review of the Literature

Abstract

The position of hysteroscopy in current fertility practice is under debate. There are many randomized controlled trials on technical feasibility and patient compliance demonstrating that the procedure is well tolerated and effective in the treatment of intrauterine pathologies. However, no consensus on the effectiveness of hysteroscopic surgery in improving the prognosis of subfertile women is available. A literature review was performed to explore the available information regarding the role of hysteroscopy in the evaluation and management of female infertility as well as to ascertain evidence that treatment of these uterine abnormalities improves fertility. The debate regarding the role of hysteroscopic surgery in the management of female infertility remains as the published studies did not reach a consensus on the benefit of such an intervention in this setting. The randomized trials do not clearly demonstrate that surgical correction of all intrauterine abnormalities improves IVF outcome. However, published observational studies suggest a benefit for resection of submucosal leiomyomas, adhesions, and endometrial polyps in increasing pregnancy rates. More randomised controlled studies are needed to substantiate the effectiveness of the hysteroscopic removal of suspected intrauterine pathology in women with unexplained subfertility or prior to assisted reproductive technology.

Hysteroscopy in recurrent in-vitro fertilisation failure (TROPHY): a multicentre, randomised controlled trial

“…[8][9][10][11] Routine outpatient hysteroscopy before starting in vitro fertilisation treatment has been proposed as a tool to confirm or restore normality of the uterine cavity and improve in vitro fertilisation treatment outcome. [12][13][14] A systematic review of published studies has suggested that outpatient hysteroscopy performed in the menstrual cycle preceding an in vitro fertilisation treatment cycle could significantly increase the clinical pregnancy rate in women who had previously experienced recurrent implantation failure, even when no hysteroscopic abnormality was detected. 15 However, the review included five single-centre heterogeneous studies, of which only two were randomised trials lacking clear description of the method of randomisation, allocation concealment, adjustment for important confounding variables and sufficient live birth data, and thus suffering from a risk of bias.…”

The Endometrium Biopsy and Hystero-Laparoscopy in Evaluation of Women’s Infertility. A Prospective Study in Algeria

“…Benign abnormalities are thought to be associated with poor endometrial receptivity and necessitate evaluation of the uterine cavity [7]. Evaluation of the uterine cavity is a basic step in female infertility workup [8]. Today, hysteroscopy is considered the gold standard for evaluation the uterine cavity, and due to improved endoscopic developments, can be performed reliably and safely as an office procedure [9].…”

Does the time interval between hysteroscopic polypectomy and start of in vitro fertilization affect outcomes?

“…Endometrial polyps, as well as other intrauterine lesions, such as leiomyomata or septae, can affect implantation of a healthy embryo (2)(3)(4) and are implicated in the pathogenesis of subfertility and early pregnancy loss, though the association is controversial (5,6). Although isolated uterine-associated infertility can be found in 2%-3% of infertile women (7), intrauterine lesions may be found in $40%-50% of subfertile or infertile women (5)(6)(7). Previous observational studies have suggested that resection of endometrial polyps can help to increase natural conception rates as well as increase pregnancy rates with the use of assisted reproduction (8)(9)(10)(11)(12)(13).…”