Pre-IVF Hysteroscopy

What is Hysteroscopy?

• 1. “Hystero” means “uterus” and “scopy” stands for “visualization”. Hysteroscopy is the visualization of the uterine cavity by by an endoscopic instrument, called “Hysteroscope”, inserted through the cervix.
• 2. If hysteroscopy is done for evaluating the uterine cavity only, it is called a diagnostic hysteroscopy, however, if any pathology is detected in the uterine cavity necessitates treatment the procedure is called an operative hysteroscopy.

Indications of Hysteroscopy

• 1. Infertility - routine as a part of infertility workup
• 2. Abnormal USG or HSG findings like polyps, septum, adhesions, Fibroids Repeated implantation failures
• 3. Persistently thin endometrium
• 4. Pre-IVF evaluation of uterine cavity
• 5. Abnormal Uterine bleeding
• 6. Severe dysmenorrhoea for suspicion of adenomyosis
• 7. Recurrent abortions
• 8. Evaluation prior to hormone replacement therapy
• 9. Suspected retained products of conception
• 10. Intrauterine device – to look for missing device and removal.

Pre IVF Hysteroscopy

• 1. Screening hysteroscopy in woman prior to IVF may reveal intrauterine pathology that may not be detected by routine transvaginal sonography or HSG.
• 2. Reported rates of intrauterine pathology in women undergoing first IVF and women with RIF are 12% and 27%, respectively.
• 3. Hysteroscopy allows detection and treatment of many of these intrauterine pathologies, which may improve IVF outcomes.
• 4. Cervical dilation during pre-IVF hysteroscopy may facilitate subsequent embryo transfers, which could possibly improve outcomes.
• 5. Another proposed mechanism to help improve IVF outcomes following hysteroscopy is local endometrial injury caused during the invasive procedure. The inflammatory reaction following endometrial injury leads to release of cytokine and growth factors that may help implantation and improve clinical pregnancy rates following IVF.

PreIVF Hysteroscopy and IVF Outcomes

• 1. Pre IVF hysteroscopy may improve the implantation rate and clinical pregnancy rates.
• 2. It failed to improve live birth rates and does not affect the miscarriage rate in women with RIF undergoing IVF.
• 3. Hysteroscopy prior to IVF may not reduce the miscarriage rates in women with recurrent abortions.