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

  • Gynecologic Endocrinology and Reproductive Medicine
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Archives of Gynecology and Obstetrics Aims and scope Submit manuscript



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.


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


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.


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.


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

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  1. Bouwmans CA, Lintsen BM, Eijkemans MJ, Habbema JD, Braat DD, Hakkaart L (2008) A detailed cost analysis of in vitro fertilization and intracytoplasmic sperm injection treatment. Fertil Steril 89(2):331–341

    Article  PubMed  Google Scholar 

  2. Fatemi HM, Kasius JC, Timmermans A, van Disseldorp J, Fauser BC, Devroey P, Broekmans FJ (2010) Prevalence of unsuspected uterine cavity abnormalities diagnosed by office hysteroscopy prior to in vitro fertilization. Hum Reprod 25(8):1959–1965

    Article  CAS  PubMed  Google Scholar 

  3. Rogers PA, Milne BJ, Trounson AO (1986) A model to show human uterine receptivity and embryo viability following ovarian stimulation for in vitro fertilization. J In Vitro Fert Embryo Transf 3(2):93–98

    Article  CAS  PubMed  Google Scholar 

  4. Makrakis E, Hassiakos D, Stathis D, Vaxevanoglou T, Orfanoudaki E, Pantos K (2009) Hysteroscopy in women with implantation failures after in vitro fertilization: findings and effect on subsequent pregnancy rates. J Minim Invasive Gynecol 16(2):181–187

    Article  PubMed  Google Scholar 

  5. Bosteels J, Weyers S, Puttemans P, Panayotidis C, Van Herendael B, Gomel V, Mol BW, Mathieu C, D’Hooghe T (2010) The effectiveness of hysteroscopy in improving pregnancy rates in subfertile women without other gynaecological symptoms: a systematic review. Hum Reprod Update 16(1):1–11

    Article  PubMed  Google Scholar 

  6. Smit JG, Jenneke CK, Marinus JC Eijkemans et al (2012) The inSIGHT study: costs and effects of routine hysteroscopy prior to a first IVF treatment cycle. A randomised controlled trial. BMC Women’s Health 12:22 Page 2 of 6.

  7. Crosignani PG, Rubin BL (2000) Optimal use of infertility diagnostic tests and treatments, The ESHRE Capri Workshop Group. Hum Reprod 15(3):723–732

    Article  CAS  PubMed  Google Scholar 

  8. El-Mazny A, Abou-Salem N, El-Sherbiny W, Saber W (2011) Outpatient hysteroscopy: a routine investigation before assisted reproductive techniques? Fertil Steril 95(1):272–276

    Article  PubMed  Google Scholar 

  9. Koskas M, Mergui JL, Yazbeck C et al (2010) Office hysteroscopy for infertility: a series of 557 consecutive cases. Obstet Gynecol Int, 168096–168096

  10. Brown SE, Coddington CC, Schnorr J, Toner JP, Gibbons W, Oehninger S (2000) Evaluation of outpatient hysteroscopy, saline infusion hysterosonography, and hysterosalpingography in infertile women: a prospective, randomized study. Fertil Steril 74(5):1029–1034

    Article  CAS  PubMed  Google Scholar 

  11. Bahadur A, Malhotra N, Singh N, Gurunath S, Mittal S (2013) Comparative study on the role of diagnostic hysteroscopy in evaluation of the uterine cavity prior to in vitro fertilization in a developing country. Arch Gynecol Obstet 288(5):1137–1143. doi:10.1007/s00404-013-2842-8 (Epub 2013 Apr 20)

    Article  PubMed  Google Scholar 

  12. Fadhlaoui A, Khediri Z, Khrouf M, Chaker A, Zhioua F (2013) Diagnostic hysteroscopy before the first in vitro fertilization. For whom? Tunis Med 91(5):310–316

    PubMed  Google Scholar 

  13. Adams SM, Gayer N, Terry V, Murphy CR (2001) Manipulation of the follicular phase: uterodomes and pregnancy—is there a correlation? BioMED Central Pregnancy Childbirth

  14. Li Rong, Hao Guiqin (2009) Local injury to the endometrium: its effect on implantation. Curr Opin Obstet Gynecol 21:236–239

    Article  CAS  PubMed  Google Scholar 

  15. Takahashi KMT, Tomiyama T, Oka C (2000) High pregnancy rate after hysteroscopy with irrigation of the uterine cavity prior to blastocyst transfer in patients who have failed to conceive after blastocyst transfer. Fertil Steril 74:S206

    Article  Google Scholar 

  16. Bohlmann MK, von Wolff M, Luedders DW, Beuter-Winkler P, Diedrich K, Hornemann A, Strowitzki T (2010) Hysteroscopic findings in women with two and with more than two first-trimester miscarriages are not significantly different. Reprod Biomed Online 21(2):230–236. doi:10.1016/j.rbmo.2010.04.016 (Epub 2010 Apr 24)

    Article  PubMed  Google Scholar 

  17. Zhang D, Zhu Y, Gao H, Zhou B, Zhang R, Wang T, Ding G, Qu F, Huang H, Lu X (2010) Overweight and obesity negatively affect the outcomes of ovarian stimulation and in vitro fertilisation: a cohort study of 2628 Chinese women. Gynecol Endocrinol 26(5):325–332. doi:10.3109/09513591003632100

    Article  PubMed  Google Scholar 

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We would like to acknowledge Dr. Emad R. H. Issak (ClinAmygate) for his efforts in statistical analysis and preparation of this manuscript.

Conflict of interest

The authors have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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Correspondence to Khaled Ahmed Abdel Aziz Elsetohy.

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Elsetohy, K.A.A.A., Askalany, A.H., Hassan, M. et al. Routine office hysteroscopy prior to ICSI vs. ICSI alone in patients with normal transvaginal ultrasound: a randomized controlled trial. Arch Gynecol Obstet 291, 193–199 (2015).

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