Office hysteroscopy before first in vitro fertilization. A randomized controlled trial.

Autor: Ben Abid H; Department of Reproductive Medicine, Farhat Hached Teaching Hospital, Ibn Jazzar Avenue, Sousse Ezzouhour, 4031, Tunisia. Electronic address: haifa.benabid@hotmail.fr., Fekih M; Department of Reproductive Medicine, Farhat Hached Teaching Hospital, Ibn Jazzar Avenue, Sousse Ezzouhour, 4031, Tunisia. Electronic address: fekihm2002@yahoo.fr., Fathallah K; Department of Reproductive Medicine, Farhat Hached Teaching Hospital, Ibn Jazzar Avenue, Sousse Ezzouhour, 4031, Tunisia. Electronic address: khadija.fathallah@gmail.com., Chachia S; Department of Reproductive Medicine, Farhat Hached Teaching Hospital, Ibn Jazzar Avenue, Sousse Ezzouhour, 4031, Tunisia. Electronic address: salmachachia@gmail.com., Bibi M; Department of Reproductive Medicine, Farhat Hached Teaching Hospital, Ibn Jazzar Avenue, Sousse Ezzouhour, 4031, Tunisia. Electronic address: hammadi.bibi@yahoo.fr., Khairi H; Department of Reproductive Medicine, Farhat Hached Teaching Hospital, Ibn Jazzar Avenue, Sousse Ezzouhour, 4031, Tunisia. Electronic address: hedi.khairi@rns.tn.
Jazyk: angličtina
Zdroj: Journal of gynecology obstetrics and human reproduction [J Gynecol Obstet Hum Reprod] 2021 Sep; Vol. 50 (7), pp. 102109. Date of Electronic Publication: 2021 Mar 13.
DOI: 10.1016/j.jogoh.2021.102109
Abstrakt: Background: Implantation failure remains a mystery since decades. This procedure needs a "top quality embryo" and a "normal" uterine cavity. To assess uterine cavity before first in vitro fertilization (IVF), many diagnostic tools could be used. Hysteroscopy remains the gold standard to diagnose and treat intra-uterine anomalies. However, it is not clearly recommanded to offer an office hysteroscopy before first IVF when transvaginal ultrasound (TVUS) and hysterosalpingography (HSG) were normal.
Purpose: This study aimed to assess the role of office hysteroscopy before first IVF when no intra-uterine anomalies are suspected.
Basic Procedures: We conducted a randomized controlled trial including 171 women scheduled for their first IVF. Women were assigned to either Group I: office hysteroscopy before IVF or Group II: immediate IVF. We included women aged less than 40 years, having regular cycles, FSH levels less than10UI/l, antral follicular count ≥12, normal TVUS and HSG. Their body mass index (BMI) ranged from 19 to 30 kg/m 2 . We excluded patients known having severe endometriosis, polycystic ovarian syndrome (PCOS) and oocyte receivers. The primary outcome were livebirth rate and clinical pregnancy rate.
Main Fundings: Between january 2016 and september 2017, we randomly assigned 171 women to either Group I (n = 84) or Group II (n = 87). Hysteroscopy was done in the mid-follicular phase immediately before IVF. Baseline characteristics and IVF features were comparable between groups except for the IVF protocol. Live birth rate was 23,9% in Group I versus 19,3% in Group II. (p = 0,607). Clinical Pregnancy rate was 32,4% in Group I versus 21,7% in Group II. (p = 0,326). No statistical significance was observed for neither miscarriage rate nor multiple pregnancy rate. Hysteroscopy showed 30% unsuspected intra-uterine anomalies: 11 intra-uterine adhesions, 7 polyps, 7 clinical endometritis and one fibroid print. Therapeutic hysteroscopy was done only for 6 intra-uterine adhesions and 3 polyps. Other anomalies did not require operative hysteroscopy. Visual analog score during hysteroscopy was 4,69 +/-2,892. 5 women (6%) of Group I experienced discomfort during diagnostic hysteroscopy. Only one patient had vagal syncope. No further complications were observed.
Principal Conclusions: Office hysteroscopy before first IVF seems not improve IVF results. Minimal intra-uterine anomalies not diagnosed by transvaginal ultrasound and hysterosalpingography do not seem to reduce IVF results.
Competing Interests: Declaration of Competing Interest The authors report no declarations of interest.
(Copyright © 2021 Elsevier Masson SAS. All rights reserved.)
Databáze: MEDLINE
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