SALINE ULTRASOUND VERSUS OFFICE HYSTEROSCOPY FOR UTERINE CAVITY EVALUATION PRIOR TO IVF: A RANDOMIZED CONTROLLED TRIAL

Abstract

Saline infusion sonography (SIS) and hysteroscopy are commonly employed methods for uterine cavity evaluation prior to fertility treatment. We aim to compare SIS and office hysteroscopy with respect to patient and provider satisfaction, and to evaluate the capability of office hysteroscopy to manage intra-uterine pathology at the time of diagnosis to reduce delays and supernumerary procedures. Prospective randomized controlled trial. Sixty women undergoing routine cavity evaluation prior to in vitro fertilization (IVF) were randomized to either SIS or office hysteroscopy without use of anesthetic. The LiNAscope disposable 4.2mm hysteroscope with operative port was used, with employment of hysteroscopic graspers as indicated. Abnormalities on SIS were subsequently managed by hysteroscopy. Management of abnormalities on hysteroscopy was attempted within the same screening procedure. Patients and providers completed surveys with findings and Likert rating scales for satisfaction and pain scores, respectively. The sample size was based on a power analysis to detect in the primary outcome of patient satisfaction scores. Statistical comparisons were performed with t-test or Mantel-Haenszel chi-square as applicable. The study groups did not differ in age, race, body mass index, indication for IVF, or history of uterine pathology. Pain scores (10 point scale) did not differ between SIS and hysteroscopy (respectively, 2.70 ±1.84 vs. 3.32 ±1.89; p = 0.20). Time to complete the procedure, patient and provider satisfaction scores, and incidence of pathology did not differ between groups (Table 1). Of the 11 patients with abnormalities in the hysteroscopy group, 10 underwent immediate attempt at operative management (one with unicornuate uterus diagnosed), with 9/10 experiencing complete resolution of pathology. Office hysteroscopy and SIS were similar with respect to patient satisfaction, tolerability, and time to complete. Both can be considered well-tolerated screening tools. However, office hysteroscopy often allowed for immediate management of abnormalities detected during uterine cavity evaluation, reducing the need for additional procedures.Table 1Comparison of results and management between SIS and office hysteroscopySIS (n = 30)Hysteroscopy (n = 30)P-ValueTime to complete (min)3.69 (±1.49)4.22 (±2.12)0.27Patient satisfaction (1-5)4.83 (±0.59)4.77 (±0.68)0.69Provider satisfaction (1-5)Uterine cavity evaluation4.73 (±0.52)4.80 (± 0.76)0.69Perception of pain4.76 (±0.63)4.70 (± 0.60)0.67Overall satisfaction4.6 (±0.77)4.73 (± 0.83)0.52Pathology found6 (20%)11 (36.7%)0.15Second procedure needed6 (20%)1 (0.03%)0.04 Open table in a new tab