The effectiveness of hysteroscopy in improving pregnancy rates in subfertile women without other gynaecological symptoms: a systematic review.
BACKGROUND
Although hysteroscopy is frequently used in the management of subfertile women, a systematic review of the evidence on this subject is lacking.


METHODS
We summarized and appraised the evidence for the benefit yielded by this procedure. Our systematic search was limited to randomized and controlled studies. The QUOROM and MOOSE guidelines were followed. Language restrictions were not applied.


RESULTS
We identified 30 relevant publications. Hysteroscopic removal of endometrial polyps with a mean diameter of 16 mm detected by ultrasound doubles the pregnancy rate when compared with diagnostic hysteroscopy and polyp biopsy in patients undergoing intrauterine insemination, starting 3 months after the surgical intervention [relative risk (RR) = 2.3; 95% confidence interval (CI): 1.6-3.2]. In patients with one fibroid structure smaller than 4 cm, there was a marginally significant benefit from myomectomy when compared with expectant management (RR = 1.9; 95% CI: 1.0-3.7). Hysteroscopic metroplasty for septate uterus resulted in fewer pregnancies in patients with subfertility when compared with those with recurrent pregnancy loss (RR = 0.7; 95% CI: 0.5-0.9). Randomized controlled studies on hysteroscopic treatment of intrauterine adhesions are lacking. Hysteroscopy in the cycle preceding a subsequent IVF attempt nearly doubles the pregnancy rate in patients with at least two failed IVF attempts compared with starting IVF immediately (RR = 1.7; 95% CI: 1.5-2.0).


CONCLUSIONS
Scarce evidence on the effectiveness of hysteroscopic surgery in subfertile women with polyps, fibroids, septate uterus or intrauterine adhesions indicates a potential benefit. More randomized controlled trials are needed before widespread use of hysteroscopic surgery in the general subfertile population can be justified.
Bosteels
Jan
J
Department of Obstetrics and Gynaecology, Imeldahospital, Bonheiden, Belgium. jan.bosteels@imelda.be
Weyers
Steven
S
Puttemans
Patrick
P
Panayotidis
Costas
C
Van Herendael
Bruno
B
Gomel
Victor
V
Mol
Ben W J
BW
Mathieu
Chantal
C
D'Hooghe
Thomas
T
D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D015907:Hysteroscopy; D007247:Infertility, Female / Q000601:surgery*; D007889:Leiomyoma / Q000601:surgery; D011127:Polyps / Q000473:pathology / Q000601:surgery; D011247:Pregnancy; D018873:Pregnancy Rate; D016032:Randomized Controlled Trials as Topic; D000267:Tissue Adhesions / Q000601:surgery; D016896:Treatment Outcome; D014591:Uterine Diseases / Q000601:surgery