The Role of Minimally Invasive Intrauterine Surgery in Improving the Results of IVF Programs

Abstract

<h3>Study Objective</h3> to determine the intrauterine pathology in women preparing for IVF and to evaluate the impact of minimally invasive intrauterine interventions on the success of subsequent IVF programs. <h3>Design</h3> prospective observational study, Level II, Canadian Task Force. <h3>Setting</h3> Department of Operative Gynecology, National Medical Research Center of Obstetrics, Gynecology and Perinatology named after V.I. Kulakov, Moscow, Russia. <h3>Patients or Participants</h3> 600 patients preparing for IVF program underwent diagnostic hysteroscopy. <h3>Interventions</h3> All patients underwent diagnostic or operative hysteroscopy on the 5th-8th day of the menstrual cycle. The patients included in the study received infertility treatment following the IVF protocol with controlled ovarian stimulation. <h3>Measurements and Main Results</h3> 36% of the examined patients had normal endometrial morphology, 42.7% had benign endometrial pathology (23.3% had chronic endometritis, 18.3% had endometrial hyperplastic processes), 5.5% of women had atypical hyperplasia and endometrial cancer. 15.9% had other intrauterine pathology. The average duration of infertility was 5.8±0.6 years, 42% of women could not achieve reproduction for more than 5 years, 59.8% had a history of ineffective IVF programs. Based on analysis of data 1 year after embryo transfer, pregnancy occurred in 62% of women. 51% of pregnancies ended in successful childbirth. <h3>Conclusion</h3> Intrauterine pathology that required hysteroscopic evaluation and treatment was observed in 58.5% of women with infertility. Surgical and subsequent conservative treatment of intrauterine pathology contributed to a reduction of the frequency of pregnancy losses (OR 1.4, 95%CI 1,0-2,0), as well as an increase in the frequency of pregnancies that ended in childbirth <b>(</b>OR 1.7, 95% CI 1,2-2,6), on average 1.5 times.