Role of Diagnostic Hysteroscopy before the First Trial of ICSI/IVF

Abstract

Aim of the work In the present study we have evaluated intrauterine pathologies using hysteroscopy in patients scheduled for intracytoplasmic sperm injection (ICSI). Methodology: This prospective randomized study included 140 female patients (21-40 years) referred to hysteroscopy unit, Dar El-Teb Hospital and Egyptian Center of ICSI. Patients were randomized into 2 groups: No hysteroscopy group (70 patients with age 28.7 ± 3.5 years) andHysteroscopy group (70 patients with age 27.4 ± 4.9 years), there was non significant difference between both groups regarding age. All participating patients were subjected to full history taking, general and pelvic examination. They had counslling about hysteroscopy procedure and who were subjected to hysteroscopy had a written consent. Then patients were subjected to either TVS and HSG or hystroscope. Results: Results of the current study show that: Abnormal hysteroscopic findings in patients subjected to hysteroscopy were 20 (28.6%) patients, the mean findings were solitary endometrial polyp in 5 (7.1%) patients, multiple endometrial polyps in 6 (8.6%) patients, adhesions in 3 (4.3%) patients, tubal block in 3 (4.3%) and uterine septum in 3 (4.3%) patients. Regarding interventions during hysteroscopy, 6 (30%) patients had polypectomy, 7 (35%) had D&C, 4 (20%) had adhesiolysis and 3 (15%) had septum resection. Nineteen (29.2%) had abnormal HSG findings and five (9.4%) patients had abnormal US findings. Clinical pregnancy was obtained in 63 (90%) of no-hystroscopy group and in 66 (94.3%) in hysteroscopy group, this difference was non statistically significant. Regarding fate of pregnancy there was statistically significant higher live birth in hysteroscopy group (91.4%) compared to no-hystroscopy group (65.7%). The experimental treatment (i.e., hysteroscopy) is helpful (compared to control), and the number needed to treat (NNT) or to benefit is greater than 7.6.