ROLE OF HYSTEROSCOPY PRIOR TO ASSISTED REPRODUCTIVE TECHNIQUE

ABSTRACT INTRODUCTION: In-vitro fertilization (IVF) is considered to be one of the major medical breakthroughs of the 20th century. However, only 25–30% of cycles of IVF and intracytoplasmic sperm injection (ICSI) lead to success. The cause of this implantation failure is poorly understood but is thought to be determined by both the embryo and the uterine cavity. Studies suggest the most frequent cause to be chromosomal abnormalities in the embryo, but abnormalities of the uterine cavity such as polyps, myoma, septum and adhesions are also thought to be associated with impaired implantation and reduced chance of pregnancy. Hysteroscopy is regarded as the reference standard to detect these uterine abnormalities. Hence, ruling out any evidence of any intrauterine pathology by hysteroscopy becomes an important step before subjecting the patent to IVF. The aim of the present study is to assess whether pre IVF Hysteroscopy improves the clinical pregnancy rate in women undergoing assisted reproductive techniques. METHODS: The study is a retrospective study of 503women who attended our infertility clinic over a period of last 6 months (January 2018 to October 2018).All women who opted for pre IVF hysteroscopy were taken as Group A and those who denied were grouped under Group B. Intrauterine lesions, such as, synechiae, polyps, submucosal myomas, septae, and so on, were treated with scissors and resectoscope. The primary outcome was positive clinical pregnancy rate (Bhcg –positive). RESULTS: Between Jan 2018, and Oct 2018, we randomly assigned 503 women to receive either hysteroscopy (Group A=291) or immediate IVF (Group B=212) without undergoing hysteroscopy. Among Group A (291), those with normal uterine cavity were assigned as Group Aa (237) and those with abnormal finding assigned as Group Ab (54). Group A had normal finding in 237 patients (Group Aa) ,out of which 85 had positive pregnancy outcome(35.86%) compared to (Group Ab) with abnormal finding being corrected in 54 women, out of which 19 had positive pregnancy(35.18%).There was no statistical significance in pregnancy rate in Group B compared neither to Group A nor the subgroups of Group A. CONCLUSION: Routine hysteroscopy before IVF in women does not improve the clinical pregnancy rate .Further research into the effectiveness of surgical correction of specific uterine cavity abnormalities before IVF is warranted