Routine office hysteroscopy prior to ICSI vs. ICSI alone in patients with normal transvaginal ultrasound: a randomized controlled trial.

BACKGROUND

Implantation failure represents a major cause of stress to both clinician and patient undergoing ICSI cycle. Even minor uterine cavity abnormalities, such as endometrial polyps, small submucous myomas, adhesions, and septa are considered to have a negative impact on the chance to conceive through ICSI.

AIM: This study aimed at assessing the role of using the office hysteroscopy as a routine investigation in improving ICSI pregnancy rates.

METHODOLOGY: ICSI was performed in two groups of infertile women with no abnormality detected in transvaginal ultrasonographic examination, group I: n = 97 and group II: n = 96, women in group I were subjected to hysteroscopic examination before ICSI while group II underwent ICSI without hysteroscopy. Then, ICSI was performed for all subjects of the two study groups with no statistically significant difference (p > 0.05) regarding the number of oocytes retrieved and the number of embryo transfer. Then, all subjects were followed up for 3 weeks after embryo transfer for detection of pregnancy by ultrasound.

RESULTS

43.3 % of group I showed abnormal hysteroscopic findings. Group I showed a significantly higher pregnancy rate (70.1 %) than that of group II (45.8 %) (p = 0.001). There is statistically significant association between the use of hysteroscopy prior to ICSI and the rate of pregnancy (OR 2.77, 95 % CI [1.53-5.00]). In addition, hysteroscopy had detected abnormalities in near half of cases whose ultrasound was normal.

CONCLUSION

Routine office hysteroscopy is an essential step for infertility workup before ICSI even in patients with normal TV/US.