Routine Hysteroscopy before First Intra Cytoplasmic Sperm Injection Cycle: A Randomized Controlled Trial

Abstract

Intra cytoplasmic sperm injectionan expensive treatment but results in a successful outcome in only a third of treatment cycles. Assisted Reproductive Technology procedures for culturing and transferring embryos have been continually improved over the last two decades and the clinical pregnancy rate has not substantially improved over the last ten years. Implantation failure could be due to a variety of reasons including embryo quality and uterine receptivity but remains unexplained in many cases. The presence of uterine pathology may negatively affect the chance of implantation. The prevalence of unsuspected uterine pathology in asymptomatic women with implantation failure has been reported to be as high as 50%. Hysteroscopy doesn’t only provide accurate visual assessment of the uterine cavity, but also gives a chance to treat any pathology detected during the examination and availability of hysteroscopy with smaller diameter has made the use of office hysteroscopy feasible as a routine examination. There is evidence that performing hysteroscopy before starting ICSI treatment could increase the chance of pregnancy in the subsequent ICSI cycle in women who had one or more failed ICSI cycles. Infertility related to uterine cavity abnormalities has been estimated to be the causal factor in as many as 10% to 15% of couples seeking treatment. Moreover, abnormal uterine findings have been found in 34% to 62% of infertile women. Hysteroscopy is considered the gold standard for evaluating the uterine cavity, and due to improved endoscopic developments, can be performed reliably and safely as an office procedure.