Diagnostic hysteroscopy: its value in an in-vitro fertilization/embryo transfer unit.
A total of 324 patients participating in our in-vitro fertilization/embryo transfer (IVF) programme underwent a diagnostic hysteroscopy. Of these, 152 women were referred before their first IVF attempt, because of some hysterosalpingographic suspicion of an intra-uterine abnormality; the other 172 patients had failed to conceive after IVF and transfer of good quality embryos. An intra-uterine pathology (mainly intra-uterine adhesions) was diagnosed in 50% of the patients in each group. Hysterosalpingography, although very sensitive, had low specificity (23%), a false positive rate of 44% and false negative rate of 10%. The main risk factor for intra-uterine pathology was a previous abortion. Conception rates were 22% after surgical treatment and 38% after the diagnostic procedure. We think that hysteroscopy should be performed in every patient failing to conceive after replacement of good quality embryos. It is also recommended whenever a suspicious finding is revealed by hysterosalpingography, before IVF. Routine hysteroscopy before entering an IVF programme should be seriously considered.
Golan
A
A
Department of Obstetrics and Gynaecology, Assaf Harofeh Medical Centre, Affiliated to Sackler School of Medicine, Tel Aviv University, Israel.
Ron-El
R
R
Herman
A
A
Soffer
Y
Y
Bukovsky
I
I
Caspi
E
E
D000328:Adult; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D015907:Hysteroscopy; D007247:Infertility, Female / Q000175:diagnosis* / Q000209:etiology; D012680:Sensitivity and Specificity; D000267:Tissue Adhesions / Q000150:complications / Q000175:diagnosis / Q000209:etiology; D014591:Uterine Diseases / Q000473:pathology; D014599:Uterus / Q000601:surgery*