Diagnostic hysteroscopy before IVF: Which women are candidates?

Abstract

Objective: Empirically, hysteroscopy before IVF has been suggested to be performed in women with repeated IVF failures. We aimed to analyse the basis for this indication, and also, to determine other possible predictors for a uterine pathology before an IVF cycle. Materials and Methods: One-hundred-seventy-six consecutively seen women, who were screened for an intrauterine pathology before the IVF cycle by using office hysteroscopy, were analysed in this retrospective analysis. Women with an endometrial pathology were compared to those without any pathology with respect to their clinical characteristics, such as age, duration of infertility, type of infertility, history of previous curettage, cause of infertility and number of previous embryo transfers. Logistic regression analysis was used for the statistical analysis. Results: In 16% of subjects, a pathology was observed; 39% of these women had endometrial polyps, 32% had endometrial adhesions, 18% had uterine septum and 11% had leiomyomas. Regression analysis revealed that the number of previous IVF-ET failures was the only predictor for a uterine pathology. Women with at least one IVF-ET failure were 2.7 times more likely to have an endometrial pathology than those, who had no failures. Odds ratios were 3.2 for women with two or more failures, and 4.7 for those with three or more failures. There was an increasing trend in odds ratios with increasing number of IVF failures. Conclusion: Women with any previous number of IVF failures are good candidates for screening for endometrial pathology before IVF. Increasing number of failures increases the risk for detecting a lesion in the cavity.