Hysteroscopy in Improving the Reproductive Outcomes of Infertile Couples

Abstract

The position of hysteroscopy in current fertility practice is under a strong and long-lasting debate. There are many randomized controlled trials on technical feasibility and patient compliance demonstrating that the procedure is well tolerated and effective in the diagnosis and the treatment of the intrauterine pathologies. However, no consensus on the effectiveness of any diagnostic and/or operative hysteroscopy in improving the reproductive outcomes of infertile women, with or without any intrauterine pathology, is still available to the scientific community. Indeed, the debate regarding the role of diagnostic and/or operative hysteroscopy in the infertility workup remains open, as the published studies did not reach a consensus on the benefit of such a procedure in these specific populations. From one side, the randomized trials do not clearly demonstrate that diagnostic hysteroscopy or the surgical correction of any intrauterine abnormalities improves the reproductive prognosis or, in women undergoing assisted reproductive technology (ART), any in vitro fertilization (IVF) outcome. However, interestingly, from the other side, almost the totality of the published observational studies suggests a benefit for resection of uterine septa, submucosal leiomyomas, adhesions, and endometrial polyps in increasing pregnancy rates. This chapter explores 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 any detected uterine abnormalities improves fertility.