Effect of hysteroscopic examination on the outcome of in vitro fertilization

Abstract

Bacground/Aim. Implantation failure after embryo transfer is one of the main problems of in vitro fartilization (IVF) and intrauterine pathologies can lead to unsuccessful outcome. The aim of this study was to determine if hysteroscopic examination of uterine cavity and consequent treatment of intrauterine lesions prior to IVF could improve the pregnancy rate in women under 38. Methods. This study included 480 patients under 38, who had undergone IVF or IVF\ICSI - embryo transfer cycles, in which one or more good quality embryos were transferred. By transvaginal sonography performed within the past 2 months, the uterus was found normal in all the patients enrolled in our IVF unit. The patients were divided into three groups: group A - with no hysteroscopic evaluation and no pathology, group B - with hysteroscopy but no pathology, and group C - with abnormal hysteroscopy finding and corresponding treatment. Results. The obtained results revaled no difference in the mean age, duration of infertility, number of mature oocytes in either group (p > 0.05). Clinical pregnancy rates in the groups A, B and C were 36.9%, 58.75% and 32.7%, respectively, and delivery rates were 27.5%, 48.7% and 25.7%, respectively. There was a statistically significant difference among the groups concerning pregnancy and delivery rates. Conclusion. Considering the results of this study we could conclude that hysteroscopy, as a routine examination, should be performed before the first IVF-ET cycle in all patients thereby reducing the failures and then the costs of IVF-ET.Uvod/Cilj. S obzirom na to da je neuspeh implantacije nakon embriotransfera jedan od glavnih problema vantelesne oplodnje i da sama intrauterina patologija moze da bude povezana sa neuspesnim ishodom, cilj naseg istrazivanja bio je da se utvrdi da li histeroskopska pretraga matericne supljine i lecenje patoloskih promena pre postupka in vitro fertilizacije (IVF) mogu poboljsati stopu trudnoce kod zena mladjih od 38 godina. Metode. Prospektivna analiza obuhvatila je 480 bolesnica mladjih od 38 godina, koje su bile podvrgnute proceduri IVF, sa jednim ili vise embriona dobrog kvaliteta za transfer. Svim bolesnicama ponudjena je histeroskopija, a onima sa pozitivnim patoloskim nalazom transvaginalnog ultrazvuka obavezno je i uradjena. Ultrazvucnim pregledom procenjeno je odsustvo patologije kavuma materice kod svih bolesnica pre zapocinjanja postupka IVF. Bolesnice su bile podeljene u tri grupe: grupa A - nikakva patologija nije otkrivena ultrazvucno i bolesnice nisu bile podvrgnute histeroskopiji; grupa B - bolesnice su bile podvrgnute histeroskopiji i nikakava patologija nije otkrivena i grupa C - bolesnice su imale abnormalan histeroskopski nalaz i bile sledstveno lecene. Rezultati. Nije nadjena statisticki znacajna razlika u prosecnoj starosti bolesnica, duzini trajanja neplodnosti i broja zrelih oocita po grupama (p > 0,05). Stopa klinicke trudnoce u grupama A, B i C bila je 36,9%, 58,75% i 32,7%, a stopa porodjaja 27,5%, 48,7% i 25,7%, respektivno. Nasli smo statisticki znacajne razlike u stopama trudnoce i porodjaja izmedju grupa. Histeroskopski uredan nalaz imalo je 80 zena (41,4%), a abnormalan nalaz 113 (58,6%). Zakljucak. Na osnovu rezultata naseg istrazivanja smatramo da histeroskopija, kao rutinska procedura, treba da se izvodi pre prvog IVF ciklusa kod svih trudnica. Na ovaj nacin redukuje se broj neuspesnih IVF ciklusa.