Diagnostic hysteroscopy before the first in vitro fertilization. For whom?

##plugins.themes.academic_pro.article.sidebar##

Published May 23, 2013
Download
pdf
Vol. 91 No. 5 (2013): Issue May 2013

##plugins.themes.academic_pro.article.main##

Anis Fadhlaoui
Zied Khediri
Mohamed Khrouf
Anis Chaker
Fethi Zhioua

Abstract

Background: For some teams, hysteroscopy, should be performed before each IVF attempt to maximize the chances of implantation because of the high cost, the investment in time and the psychological impact of each IVF cycle, but answer to the question of the systematic practice of hysteroscopy prior to IVF is far from settled.
aim: Assess the benefits of conducting a routine hysteroscopy before the first IVF / ICSI and to identify subgroups in whom this examination provides a real benefit.
methods: This is a comparative retrospective study about 334 patients, included in an IVF program with micro-injection, in the center of ART of Aziza Othmana hospital of Tunis, for a period of one year. The results of ICSI in patients with a first attempt at IVF / ICSI were compared according to the realization (HSC +) or not (HSC-) of a diagnostic hysteroscopy prior to the first IVF attempt.
results : The implantation rate in our series was 21.62%. We got a pregnancy in 128 cases, that is a pregnancy rate per transfer of 38.32%. The rate of live births was 29.34%, including 94.89% deliveries to terms with living fetus. We found no significant difference between groups "HSC +" and "HSC -" in terms of pregnancy rates of biological or clinical pregnancy rate or in terms of live births. But, in patients aged 40 and over, we found improved results of IVF in a meaningful way in the group "+ HSC”.
Conclusion : Our study finds no benefit in terms of outcomes of IVF/ ICSI to the completion of hysteroscopy in a systematic way, despite a high incidence of abnormalities detected by intra-cavity examination. The benefit of routine hysteroscopy is significant only in women 40 and older.

Keywords:

Hysteroscopy, IVF, ICSI, transfert, implantation, baby at home

##plugins.themes.academic_pro.article.details##

References

  1. Goldenber M, Bider D, Ben-Rafael Z, et al. Hysteroscopy in a program of in vitro fertilization. J In Vitro Fertil Embryo Transf 1991; 8:336-8.
  2. Berger-Menz E, Mueller MD, Eggimann T, Hanggi W, Dreher E. Diagnostic value of hysteroscopy in the evaluation of female infertility. Geburtshilfe Frauenheilkd 1999; 59:413-15.
  3. Féghali J, Bakar J, Mayenga J.M, et al. Hystéroscopie systématique avant fécondation in vitro. Gyn Obst Fert 2003;31 :127-31.
  4. Agostini, F. Franchi, F. Bretelle, V. Roger, L. Cravello, B. Blanc. Place de l'hystéroscopie diagnostique dans le bilan de l'infertilité. EMC-Elsevier Masson SAS, Gynécologie, 2005 ; 739-A-22.
  5. Schiano A, Jourdain O, Papaxanthos A, Hocke C, Horovitz J, Dallay D. The value of hysteroscopy after repeated implantation failures with in vitro fertilization. Contracept Fertil Sex 1999;27:129-32.
  6. Seneira P, Maccario S, Visentin L, DiGregorio A. Hysteroscopy in an IVF-ER program. Acta Obstet Gynecol Scand 1988; 67:135-7.
  7. La Sala GB, Dessanti L, Sacchetti F. Hysteroscopy and female sterility: analysis of the results from 213 patients. Acta Eur Fertil 1985; 16:47-9.
  8. Bakour SH, Jones SE, O'Donovan P. Ambulatory hysteroscopy: evidence-based guide to diagnosis and therapy. Best Pract Res Clin Obstet Gynaecol 2006; 20:953-75.
  9. NICE Guidelines - Clinical Guideline 11: Fertility: assessment and treatment for people with fertility problems. NICE, February 2004, 48-49.
  10. Crosignani PG, Rubin BL. Optimal use of infertility diagnostic tests and treatments. The ESHRE Capri Workshop Group. Hum Reprod 2000; 15:723-32.
  11. Royal College of Obstetricians and Gynaecologists Evidencebased Clinical Guidelines. Guideline: Fertility Assessment and Treatment for People with Fertility Problems, 2004. RCOG website.
  12. Cohen MJ, Rosenzweig TS, Revel A. Uterine abnormalities and embryo implantation: clinical opinion altered by peer debate. Reprod Biomed Online 2007; 14:555-58.
  13. Bosteels J, Weyers S, Puttemans P et al. The effectiveness of hysteroscopy in improving pregnancy rates in subfertile women without other gynaecological symptoms: a systematic review; Hum Reprod Upd 2010; 16:1-11.
  14. Oliveira FG, Abdelmassih VG, Diamond MP, Dozortsev D, Nagy ZP, Abdelmassih R. Uterine cavity findings and hysteroscopic interventions in patients undergoing in vitro fertilization-embryo transfer who repeatedly cannot conceive. Fertil Steril 2003; 80:1371-75.
  15. El-Toukhy T, Sunkara SK, Coomarasamy A, Grace J, Khalaf Y. Outpatient hysteroscopy and subsequent IVF cycle outcome: a systematic review and metaanalysis. Reprod Biomed Online 2008; 16:712-9.
  16. Demirol A, Gurgan T. Effect of treatment of intrauterine pathologies with office hysteroscopy in patients with recurrent IVF failure. Reprod Biomed Online 2004;8:590-94.
  17. Rama Raju GA, Shashi KG, Krishna KM, Prakash GJ, Madan K. Assessment of uterine cavity by hysteroscopy in assisted reproduction programme and its influence on pregnancy outcome. Arch Gynecol Obstet 2006; 274:160-64.
  18. Shamma FN, Lee G, Gutmann JN, Lavy G. The role of office hysteroscopy in in vitro fertilization. Fertil Steril 1992; 58:1237-39.
  19. Doldi N, Persico P, Di SF, et al. Pathologic findings in hysteroscopy before in vitro fertilization-embryo transfer. Gynecol Endocrinol 2005; 21:235-37.
  20. Fatemi HM, Kasius HC, Timmermans A et al. Prevalence of unsuspected uterine cavity abnormalities diagnosed by office hysteroscopy prior to in vitro fertilization. Human Reprod 2010; 25: 1959-65.
  21. Marshall LM, Spiegelman D, Barbieri RL, et al. Variation in the incidence of uterine leiomyoma among premenopausal women by age and race. Obstet Gynecol 1997;90:967-73.
  22. Hileeto D, Fadare O, Martel M, Zheng W. Age dependent association of endometrial polyps with increased risk of cancer involvement. World J Surg Oncol 2005;3:8.
  23. Hinckley MD, Milki AA. 1000 office-based hysteroscopies prior to in vitro fertilization: feasibility and findings. JSLS. 2004; 8:103-7.
  24. Souza CA, Schmitz C, Genro VK et al. Office hysteroscopy study in consecutive miscarriage patients. Rev Assoc Med Bras. 2011; 57:404-8.
  25. Weiss A, Shalev E, Romano S. Hysteroscopy may be justified after two miscarriages. Hum Reprod 2005;20:2628-31.
  26. Li TC, Makris M, Tomsu M, et al. Recurrent miscarriage: aetiology, management and prognosis. Hum Reprod Update 2002;8:463-81.