Hysteroscopy pp 237-252 | Cite as

Hysteroscopy in Improving the Reproductive Outcomes of Infertile Couples

  • Marialuigia Spinelli
  • Attilio Di Spiezio Sardo
  • Daniel Surbek
Chapter

Abstract

The position of hysteroscopy in current fertility practice is under a strong and long-lasting debate. There are many randomized controlled trials on technical feasibility and patient compliance demonstrating that the procedure is well tolerated and effective in the diagnosis and the treatment of the intrauterine pathologies. However, no consensus on the effectiveness of any diagnostic and/or operative hysteroscopy in improving the reproductive outcomes of infertile women, with or without any intrauterine pathology, is still available to the scientific community. Indeed, the debate regarding the role of diagnostic and/or operative hysteroscopy in the infertility workup remains open, as the published studies did not reach a consensus on the benefit of such a procedure in these specific populations. From one side, the randomized trials do not clearly demonstrate that diagnostic hysteroscopy or the surgical correction of any intrauterine abnormalities improves the reproductive prognosis or, in women undergoing assisted reproductive technology (ART), any in vitro fertilization (IVF) outcome. However, interestingly, from the other side, almost the totality of the published observational studies suggests a benefit for resection of uterine septa, submucosal leiomyomas, adhesions, and endometrial polyps in increasing pregnancy rates. This chapter explores the available information regarding the role of hysteroscopy in the evaluation and management of female infertility as well as to ascertain evidence that treatment of any detected uterine abnormalities improves fertility.

Keywords

Infertility Hysteroscopy In vitro fertilization Reproductive outcome Meta-analysis 

References

  1. 1.
    Hamou JE. Hysteroscopy and microcolpohysteroscopy: text and atlas. Appleton & Lange: New Haven, CT, USA; 1991.Google Scholar
  2. 2.
    Bakour SH, Jones SE, O’Donovan P. Ambulatory hysteroscopy: evidence-based guide to diagnosis and therapy. Best Pract Res Clin Obstet Gynaecol. 2006;20(6):953–75. [PubMed]CrossRefPubMedGoogle Scholar
  3. 3.
    Boivin J, Bunting L, Collins JA, Nygren KG, et al. Hum Reprod. 2007;22:1506–12.CrossRefPubMedGoogle Scholar
  4. 4.
    NICE. Fertility: assessment and treatment for people with fertility problems. National Institute for Health and Clinical Excellence; 2013. Available at: http://guidance.nice.org.uk/CG156. Last Accessed 1 Dec 2014.
  5. 5.
    Gnoth C, Godehardt D, Godehardt E, Frank-Herrmann P, Freundl G. Time to pregnancy: results of the German prospective study and impact on the management of infertility. Hum Reprod. 2003;18:1959–66.CrossRefPubMedGoogle Scholar
  6. 6.
    Zegers-Hochschild F, Adamson G, de Mouzon J, Mansour R, Nygren K, Sullivan E, Vanderpoel S, International Committee for Monitoring Assisted Reproductive Technology. World Health Organization, et al. Fertil Steril. 2009;92:1520–4.CrossRefPubMedGoogle Scholar
  7. 7.
    Impey L, Child T. Obstetrics and gynecology. Oxford, UK: Wiley-Blackwell; 2008.Google Scholar
  8. 8.
    Smith S, Pfeifer SM, Collins JA. Diagnosis and management of female infertility. J Am Med Assoc. 2003;290:1767–70.CrossRefGoogle Scholar
  9. 9.
    Pellicer A, Gaitán P, Neuspiller F, Ardiles G, Albert C, RemohíJ SC. Ovarian follicular dynamics: from basic science to clinical practice. J Reprod Immunol. 1998;39:29–61.CrossRefPubMedGoogle Scholar
  10. 10.
    Valli E, Zupi E, Montevecchi L. A new hysteroscopic classification of endometrial lesions. J Am Assoc Gynecol Laparosc. 1995;2:279–84.CrossRefPubMedGoogle Scholar
  11. 11.
    Polisseni F, Bambirra EA, Camargosa AF. Detection of chronic endometritis by diagnostic hysteroscopy in asymptomatic infertile patients. Gynecol Obstet Investig. 2003;55:205–10.CrossRefGoogle Scholar
  12. 12.
    Fabres C, Alam V, Balmaceda J, Zegers-Hochschild F, Mackenna A, Fernandez E. Comparison of ultrasonography and hysteroscopy in the diagnosis of intrauterine lesions in infertilewomen. J Am Assoc Gynecol Laparosc. 1998;5:375–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Cicinelli E, Resta L, Nicoletti R, Tartagni M, Marinaccio M, Bulletti C, Colafiglio G. Detection of chronic endometritis at fluid hysteroscopy. J Minim Invasive Gynecol. 2005;12:514–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Revel A. Defective endometrial receptivity. Fertil Steril. 2012;97:1028–32.CrossRefPubMedGoogle Scholar
  15. 15.
    Taylor E, Gomel V. The uterus and fertility. Fertil Steril. 2008;89:1–16.CrossRefPubMedGoogle Scholar
  16. 16.
    SEGI. Practical Guideline in Office Hysteroscopy; 2014. Available at: http://ebookbrowsee.net/practical-guideline-in-office-hysteroscopy-segi-pdf-d715780654. Last Accessed 1 Dec 2014.
  17. 17.
    Bosteels J, Kasius J, Weyers S, Broekmans FJ, Mol BWJ, D'Hooghe TM. Hysteroscopy for treating subfertility associated with suspected major uterine cavity abnormalities. Cochrane Database Syst Rev. 2013;(1):CD009461.Google Scholar
  18. 18.
    Carneiro MM. What is the role of hysteroscopic surgery in the management of female infertility? A review of the literature. Surg Res Pract. 2014;2014:105412.PubMedPubMedCentralGoogle Scholar
  19. 19.
    The Practice Committee of the American Society for Reproductive Medicine. Diagnostic evaluation of the infertile female: a committee opinion. Fertil Steril. 2012;98(2):302–7.CrossRefGoogle Scholar
  20. 20.
    Velde ER, Eijkemans R, Habbema HD. Variation in couple fecundity and time to pregnancy, an essential concept in human reproduction. Lancet. 2000;355:1928–9.CrossRefGoogle Scholar
  21. 21.
    Munné S, Held KR, Magli CM, Ata B, Wells D, Fragouli E, Baukloh V, Fischer R, Gianaroli L. Intra-age, intercenter, and intercycle differences in chromosome abnormalities in oocytes. Fertil Steril. 2012;97:935–42.CrossRefPubMedGoogle Scholar
  22. 22.
    Alviggi C, Humaidan P, Howles CM, Tredway D, Hillier SG. Biological versus chronological ovarian age: implications for assisted reproductive technology. Reprod Biol Endocrinol. 2009;22:101.CrossRefGoogle Scholar
  23. 23.
    Alviggi C, Humaidan P, Ezcurra D. Hormonal, functional and genetic biomarkers in controlled ovarian stimulation: tools for matching patients and protocols. Reprod Biol Endocrinol. 2012;10:9.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Bosteels J, Weyers S, Puttemans P, et al. The effectiveness of hysteroscopy in improving pregnancy rates in subfertile women without other gynaecological symptoms: a systematic review. Hum Reprod Update. 2010;16(1):1–11.CrossRefPubMedGoogle Scholar
  25. 25.
    Potdar N, Gelbaya T, Nardo LG. Endometrial injury to overcome recurrent embryo implantation failure: a systematic review and meta-analysis. Reprod Biol Med Online. 2012;25:561–71.CrossRefGoogle Scholar
  26. 26.
    El-Toukhy T, Sunkara SK, Coomarasamy A, Grace J, Khalaf Y. Outpatient hysteroscopy and subsequent IVF cycle outcome: a systematic review and meta-analysis. Reprod Biol Med Online. 2008;16:712–9.CrossRefGoogle Scholar
  27. 27.
    Pundir J, Pundir V, Omanwa K, Khalaf Y, El-Toukhy T. Hysteroscopy prior to the first IVF cycle: a systematic review and meta-analysis. Reprod Biomed Online. 2014;28:151–61.CrossRefPubMedGoogle Scholar
  28. 28.
    Di Spiezio SA, Di Carlo C, Minozzi S, Spinelli M, Pistotti V, Alviggi C, De Placido G, Nappi C, Bifulco G. Efficacy of hysteroscopy in improving reproductive outcomes of infertile couples: a systematic review and meta-analysis. Hum Reprod Update. 2016;22(4):479–96.CrossRefGoogle Scholar
  29. 29.
    Casini ML, Rossi F, Agostini R, Unfer V. Effects of the position of fibroids on fertility. Gynecol Endocrinol. 2006;22:106–9.CrossRefPubMedGoogle Scholar
  30. 30.
    Perez-Medina T, Bajo-Arenas J, Salazar F, Redondo T, Sanfrutos L, Alvarez P, Engels V. Endometrial polyps and their implication in the pregnancy rates of patients undergoing intrauterine insemination: a prospective, randomized study. Hum Reprod. 2005;20:1632–5.CrossRefPubMedGoogle Scholar
  31. 31.
    Demirol A, Gurgan T. Effect of treatment of intrauterine pathologies with office hysteroscopy in patients with recurrent IVF failure. Reprod Biol Med Online. 2004;8:590–4.CrossRefGoogle Scholar
  32. 32.
    Rama Raju GA, ShashiKumari G, Krishna KM, Prakash GJ, Madan K. Assessment of uterine cavity by hysteroscopy in assisted reproduction programme and its influence on pregnancyoutcome. Arch Gynecol Obstet. 2006;274:160–4.CrossRefPubMedGoogle Scholar
  33. 33.
    El-Nashar IH, Nasr A. The role of hysteroscopy before intracytoplasmic sperm injection (ICSI): a randomized controlled trial. Fertil Steril. 2011;96:S266.CrossRefGoogle Scholar
  34. 34.
    Elsetohy KA, Askalany AH, Hassan M, Dawood Z. Routine office hysteroscopy prior to ICSI vs. ICSI alone in patients with normal transvaginal ultrasound: a randomized controlled trial. Arch Gynecol Obstet. 2015;291:193–9.CrossRefPubMedGoogle Scholar
  35. 35.
    Shawki HE, Elmorsy M, Eissa MK. Routine office hysteroscopy prior to ICSI and its impact on assisted reproduction program outcome: a randomized controlled trial. Middle East Fertil Soc J. 2012;17:14–21.CrossRefGoogle Scholar
  36. 36.
    El-Toukhy T, Khalaf Y, Coomarasamy A, Tabanelli C, Gordts SS, Gordts S, Mestdagh G, Mardesic T, Marchino GL, Al-Shawaf T, et al. A multicenter randomized study of pre-IVF outpatient hysteroscopy in women with recurrent IVF-ET failure- the trophy trial. Hum Reprod. 2014;29:i36–7.Google Scholar
  37. 37.
    Aghahosseini M, Ebrahimi N, Mahdavi A, Aleyasin A, Safdarian L, Sina S. Hysteroscopy prior to assisted reproductive technique in women with recurrent implantation failure improves pregnancy likelihood. Fertil Steril. 2012;98:S4.CrossRefGoogle Scholar
  38. 38.
    Lorusso F, Ceci O, Bettocchi S, et al. Office hysteroscopy in an in vitro fertilization program. Gynecol Endocrinol. 2008;24(8):465–9.CrossRefPubMedGoogle Scholar
  39. 39.
    Fatemi HM, Kasius JC, Timmermans A, et al. Prevalence of unsuspected uterine cavity abnormalities diagnosed by office hysteroscopy prior to in vitro fertilization. Hum Reprod. 2010;25(8):1959–65.CrossRefPubMedGoogle Scholar
  40. 40.
    Karayalcin R, Ozcan S, Moraloglu O, Ozyer S, Mollamahmutoglu L, Batioglu S. Results of 2500 office-based diagnostic hysteroscopies before IVF. Reprod Biomed Online. 2010;20(5):689–93.CrossRefPubMedGoogle Scholar
  41. 41.
    Karayalçın R, Ozyer S, Ozcan S, et al. Office hysteroscopy improves pregnancy rates following IVF. Reprod Biomed Online. 2012;25(3):261–6.CrossRefPubMedGoogle Scholar
  42. 42.
    Cenksoy P, Ficicioglu C, Yıldırım G, Yesiladali M. Hysteroscopic findings in women with recurrent IVF failures and the effect of correction of hysteroscopic findings on subsequent pregnancy rates. Arch Gynecol Obstet. 2013;287(2):357–60.CrossRefPubMedGoogle Scholar
  43. 43.
    Bakas P, Hassiakos D, Grigoriadis C, Vlahos N, Liapis A, Gregoriou O. Role of hysteroscopy prior to assisted reproduction techniques. J Minim Invasive Gynecol. 2014;21(2):233–7.CrossRefPubMedGoogle Scholar
  44. 44.
    Tomaževič T, Ban-Frangež H, Virant-Klun I, Verdenik I, Požlep B, Vrtačnik-Bokal E. Septate, subseptate and arcuate uterus decrease pregnancy and live birth rates in IVF/ICSI. Reprod Biomed Online. 2010;21(5):700–5.CrossRefPubMedGoogle Scholar
  45. 45.
    Gaglione R, Valentini AL, Pistilli E, Nuzzi NP. A comparison of hysteroscopy and hysterosalpingography. Int J Gynecol Obstet. 1996;52:151–3.CrossRefGoogle Scholar
  46. 46.
    Golan A, Eilat E, Ron-El R, Herman A, Soffer Y, Bukovsky I. Hysteroscopy is superior to hysterosalpingography in infertility investigation. Acta Obstet Gynecol Scand. 1996;75:654–6.CrossRefPubMedGoogle Scholar
  47. 47.
    Brown SE, Coddington CC, Schnorr J, Toner JP, Gibbons W, Oebninger S. Evaluation of outpatient hysteroscopy, saline infusion hysterosonography, and hysterosalpingography in infertile women: a prospective, randomized study. Fertil Steril. 2000;74:1029–34.CrossRefPubMedGoogle Scholar
  48. 48.
    Roma Dalfó A, Ubeda B, Ubeda A, Monzon M, Rotger R, Ramos R, Palacio A. Diagnostic value of hysterosalpingography in the detection of intrauterine abnormalities: a comparison with hysteroscopy. AJR Am J Roentgenol. 2004;183(5):1405–9.CrossRefPubMedGoogle Scholar
  49. 49.
    Pundir J, El-Toukhy T. Uterine cavity assessment prior to IVF. Womens Health. 2010;6:841–8.Google Scholar
  50. 50.
    El-Toukhy T, Campo R, Sunkara SK, Khalaf Y, Coomarasamy A. A multi-centre randomised controlled study of pre-IVF outpatient hysteroscopy in women with recurrent IVF implantation failure: trial of Outpatient Hysteroscopy—[TROPHY] in IVF. Reprod Health. 2009;6:20.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Hinckley MD, Milki AA. 1000 office-based hysteroscopies prior to in vitro fertilization: feasibility and findings. J Soc Laparoendosc Surg. 2004;8:103–7.Google Scholar
  52. 52.
    Kasius JC, Fatemi HM, Timmermans A, Van Disseldorp J, Fauser BC, Devroey P, Broekmans FJ. Detection and relevance of minor intrauterine abnormalities at office hysteroscopy in asymptomatic patients indicated for IVF. Hum Reprod. 2009;24:i103Google Scholar
  53. 53.
    Takahashi K, Mukaida T, Tomiyama C, Oka C. High pregnancy rate after hysteroscopy with irrigation inuterine cavity prior to blastocyst transferrin patients who have failed to conceive after blastocyst transfer. Fertil Steril. 2000;4:S206.CrossRefGoogle Scholar
  54. 54.
    Egbase PE, Al-Sharhan M, Grudzinskas JG. Influence of position and length of uterus on implantation and clinical pregnancy rates in IVF and embryo transfer treatment cycles. Hum Reprod. 2000;15:1943–6.CrossRefPubMedGoogle Scholar
  55. 55.
    Mansour RT, Aboulghar MA. Optimizing the embryo transfer technique. Hum Reprod. 2002;17:1149–53.CrossRefPubMedGoogle Scholar
  56. 56.
    Pabuccu R, Ceyhan ST, Onalan G, Goktolga U, Ercan CM, Selam B. Successful treatment of cervical stenosis with hysteroscopic canalization before embryo transfer in patients undergoing IVF: a case series. J Minim Invasive Gynecol. 2005;12:436–8.CrossRefPubMedGoogle Scholar
  57. 57.
    Dhulkotia J, Coughlan C, Li TC, Ola B. Effect of endometrial injury on subsequent pregnancy rates in women undergoing IVF after previous implantation failure: systematic review and meta-analysis. Hum Reprod. 2012;27:ii66–7.CrossRefGoogle Scholar
  58. 58.
    Shohayeb A, El-Khayat W. Does a single endometrial biopsy regimen (S-EBR) improve ICSI outcome in patients with repeated implantation failure? A randomised controlled trial. Eur J Obstet Gynecol Reprod Biol. 2012;164:176–9.CrossRefPubMedGoogle Scholar
  59. 59.
    Mirkin S, Arslan M, Churikov D, Corica A, Diaz J, Williams S, Bocca S, Oehninger S. In search of candidate genes critically expressed in the human endometrium during the window of implantation. Hum Reprod. 2005;20:2104–17.CrossRefPubMedGoogle Scholar
  60. 60.
    Almog B, Shalom-Paz E, Dufort T, Tolandi T. Promoting implantation by local injury to the endometrium. Fertil Steril. 2010;94:2026–9.CrossRefPubMedGoogle Scholar
  61. 61.
    Smit JG, Kasius JC, Eijkemans MJ, et al. Hysteroscopy before in-vitro fertilisation (inSIGHT): a multicentre, randomised controlled trial. Lancet. 2016;387(10038):2622–9.CrossRefPubMedGoogle Scholar
  62. 62.
    El-Toukhy T, Campo R, Khalaf Y, et al. Hysteroscopy in recurrent in-vitro fertilisation failure (TROPHY): a multicentre, randomised controlled trial. Lancet. 2016;387(10038):2614–21. doi: 10.1016/S0140-6736(16)00258-0.CrossRefPubMedGoogle Scholar
  63. 63.
    Hassan M-AM, Lavery SA, Trew GH. Congenital uterine anomalies and their impact on fertility. Womens Health. 2010;6(3):443–61.Google Scholar
  64. 64.
    Chan YY, Jayaprakasan K, Zamora J, Thornton JG, Raine-Fenning N, Coomarasamy A. The prevalence of congenital uterine anomalies in unselected and high-risk populations: a systematic review. Hum Reprod Update. 2011;17(6):761–71.CrossRefPubMedPubMedCentralGoogle Scholar
  65. 65.
    Benkaddour YA, Gervaise A, Fernandez H. Which is the method of choice for evaluating uterine cavity in infertility workup? J Gynecol Obstet Biol Reprod. 2010;39(8):606–13.CrossRefGoogle Scholar
  66. 66.
    Saravelos SH, Cocksedge KA, Li T-C. Prevalence and diagnosis of congenital uterine anomalies in women with reproductive failure: a critical appraisal. Hum Reprod Update. 2008;14(5):415–29.CrossRefPubMedGoogle Scholar
  67. 67.
    Mollo A, de Franciscis P, Colacurci N, et al. Hysteroscopic resection of the septum improves the pregnancy rate of women with unexplained infertility: a prospective controlled trial. Fertil Steril. 2009;91(6):2628–31.CrossRefPubMedGoogle Scholar
  68. 68.
    Bakas P, Gregoriou O, Hassiakos D, Liapis A, Creatsas M, Konidaris S. Hysteroscopic resection of uterine septum and reproductive outcome in women with unexplained infertility. Gynecol Obstet Investig. 2012;73(4):321–5.CrossRefGoogle Scholar
  69. 69.
    Kowalik CR, Goddijn M, Emanuel MH, et al. Metroplasty versus expectant management for women with recurrent miscarriage and a septate uterus. Cochrane Database Syst Rev. 2011;(6):CD008576.Google Scholar
  70. 70.
    The Practice Committee of American Society for Reproductive Medicine in collaboration with Society of Reproductive Surgeons. Myomas and reproductive function. Fertil Steril. 2008;90(5):S125–30.CrossRefGoogle Scholar
  71. 71.
    Farquhar C, Ekeroma A, Furness S, Arroll B. A systematic review of transvaginal ultrasonography, sonohysterography and hysteroscopy for the investigation of abnormal uterine bleeding in premenopausal women. Acta Obstet Gynecol Scand. 2003;82(6):493–504.CrossRefPubMedGoogle Scholar
  72. 72.
    American Association of Gynecologic Laparoscopists (AAGL): Advancing Minimally Invasive Gynecology Worldwide. AAGL practice report: practice guidelines for the diagnosis and management of submucous leiomyomas. J Minim Invasive Gynecol. 2012;19(2):152–71.CrossRefGoogle Scholar
  73. 73.
    Filogônio IDDS, de Ávila I, Gouvea PS, Carneiro MM. Accuracy of hysteroscopic view in the diagnosis of intrauterine pathology: a Brazilian experience. J Gynecol Surg. 2010;26(1):23–30.CrossRefGoogle Scholar
  74. 74.
    Klatsky PC, Tran ND, Caughey AB, Fujimoto VY. Fibroids and reproductive outcomes: a systematic literature review from conception to delivery. Am J Obstet Gynecol. 2008;198(4):357–66.CrossRefPubMedGoogle Scholar
  75. 75.
    Salim S, Won H, Nesbitt-Hawes E, Campbell N, Abbott J. Diagnosis and management of endometrial polyps: a critical review of the literature. J Minim Invasive Gynecol. 2011;18(5):569–81.CrossRefPubMedGoogle Scholar
  76. 76.
    Stamatellos I, Apostolides A, Stamatopoulos P, Bontis J. Pregnancy rates after hysteroscopic polypectomy depending on the size or number of the polyps. Arch Gynecol Obstet. 2008;277(5):395–9.CrossRefPubMedGoogle Scholar
  77. 77.
    Shokeir TA, Shalan HM, El-Shafei MM. Significance of endometrial polyps detected hysteroscopically in eumenorrheic infertile women. J Obstet Gynaecol Res. 2004;30:84–9.CrossRefPubMedGoogle Scholar
  78. 78.
    Silberstein T, Saphier O, van Voorhis BJ, Plosker SM. Endometrial polyps in reproductive-age fertile and infertile women. Isr Med Assoc J. 2006;8:192–5.PubMedGoogle Scholar
  79. 79.
    Taylor TH, Wright G, Jones-Colon S, et al. Comparison of ICSI and conventional IVF in patients with increased oocyte immaturity. Reprod Biomed Online. 2008;17:46–52.CrossRefPubMedGoogle Scholar
  80. 80.
    Somigliana E, Vercellini P, Daguati R, et al. Fibroids and female reproduction: a critical analysis of the evidence. Hum Reprod Update. 2007;13:465–76.CrossRefPubMedGoogle Scholar
  81. 81.
    Rackow BW, Taylor HS. Submucosal uterine leiomyomas have a global effect on molecular determinants of endometrial receptivity. Fertil Steril. 2010;93:2027–34.CrossRefPubMedGoogle Scholar
  82. 82.
    Rackow BW, Jorgensen E, Taylor HS. Endometrial polyps affect uterine receptivity. Fertil Steril. 2011;95:2690–2.CrossRefPubMedPubMedCentralGoogle Scholar
  83. 83.
    Galliano D, Bellver J, Díaz-García C, Simón C, Pellicer A. ART and uterine pathology: how relevant is the maternal side for implantation? Hum Reprod Update. 2015;21:13–38.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Marialuigia Spinelli
    • 1
    • 2
  • Attilio Di Spiezio Sardo
    • 2
  • Daniel Surbek
    • 3
  1. 1.Department of Clinical ResearchUniversity of BernBernSwitzerland
  2. 2.Department of Neuroscience, Reproductive Sciences and Dentistry, School of MedicineUniversity of Naples Federico IINaplesItaly
  3. 3.Department of Obstetrics and GynecologyUniversity of BernBernSwitzerland

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