Role of pre IVF hysteroscopy in women with unexplained infertility for detecting unsuspected intrauterine lesions and effect on pregnancy outcome

Abstract

Objective: The relevance of routine hysteroscopy before IVF is debatable and there is no consensus on the effectiveness of routine pre IVF hysteroscopy in improving pregnancy outcome. The purpose of this study is to assess the role of pre IVF hysteroscopy in women with unexplained infertility in detecting unsuspected intrauterine lesions and its effect on pregnancy outcome. Materials and Methods: This was retrospective observational study conducted at Medicover Fertility Center, New Delhi, India. In the study group (n = 60), women with unexplained infertility of more than three years with normal transvaginal ultrasonography were included, where hysteroscopy was done in post-menstrual period, 1–2 months before starting IVF treatment. In the control group (n = 60), pre IVF hysteroscopy was not done. Results: The study and control group did not differ for age, body mass index, duration and type of infertility. There was a high prevalence (31.6%) of unsuspected intrauterine abnormalities in women with unexplained infertility with normal transvaginal ultrasound findings. The clinical pregnancy rate was 48.3% (29/60) in study group and 36.7% (22/60) in control group. The clinical pregnancy rate (CPR) was observationally higher in women with pre IVF hysteroscopy, but the difference was not statistically significant (P value = 0.193). Conclusion: There was high prevalence rate of unsuspected intrauterine lesions in women with unexplained infertility. Clinical pregnancy rates were not significantly higher in patients who underwent pre IVF hysteroscopy. Further larger studies and randomized controlled trials are needed to verify the positive outcome of use of hysteroscopy prior to IVF.