Korean J Women Health Nurs.  2020 Dec;26(4):300-317. 10.4069/kjwhn.2020.12.13.

The effects of diagnostic hysteroscopy on the reproductive outcomes of infertile women without intrauterine pathologies: a systematic review and meta-analysis

• Yang SY
• Chon SJ
• Lee SH

• KMID: 2510367
• DOI: http://doi.org/10.4069/kjwhn.2020.12.13

Abstract

Purpose
Hysteroscopy can be used both to diagnose and to treat intrauterine pathologies. It is well known that hysteroscopy helps to improve reproductive outcomes by treating intrauterine pathologies. However, it is uncertain whether hysteroscopy is helpful in the absence of intrauterine pathologies. This study aimed to confirm whether hysteroscopy improves the reproductive outcomes of infertile women without intrauterine pathologies.
Methods
We conducted a systematic review of 11 studies retrieved from Ovid-MEDLINE, Ovid-Embase, and the Cochrane Library. Two independent investigators extracted the data and used risk-of-bias tools (RoB 2.0 and ROBINS-I) to assess their quality.
Results
Diagnostic hysteroscopy prior to in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) was associated with a higher clinical pregnancy rate (CPR) and live birth rate (LBR) than non-hysteroscopy in patients with recurrent implantation failure (RIF) (odds ratio, 1.79 and 1.46; 95% confidence interval, 1.40–2.30 and 1.08–1.97 for CPR and LBR, respectively) while hysteroscopy prior to first IVF was ineffective. The overall meta-analysis of LBR showed statistically significant findings for RIF, but a subgroup analysis showed effects only in prospective cohorts (odds ratio, 1.40 and 1.47; 95% confidence interval, 0.86–1.56 and 1.04–2.07 for randomized controlled trials and prospective cohorts, respectively). Therefore, the LBR should be interpreted carefully and further research is needed.
Conclusion
Although further research is warranted, hysteroscopy may be considered as a diagnostic and treatment option for infertile women who have experienced RIF regardless of intrauterine pathologies. This finding enables nurses to educate and support infertile women with RIF prior to IVF/ICSI.

Keyword

Birth rate; Female infertility; Hysteroscopy; Pregnancy rate; Systematic review

Figure

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  Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram.CPR: Clinical pregnancy rate; ICSI: intracytoplasmic sperm injection; IVF: in vitro fertilization; LBR: live birth rate; NRS: non-randomized study; RCT: randomized controlled trial.

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  Figure 2. Diagnostic hysteroscopy vs. non-hysteroscopy according to the number of in vitro fertilization attempts. (A) Clinical pregnancy rate. (B) Live birth rate.df: Degree of freedom; M-H: Mantel-Haenszel; RCT: randomized controlled trial; RIF: recurrent implantation failure.

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  Figure 3. Diagnostic hysteroscopy vs. non-hysteroscopy in patients who underwent endometrial stimulation during hysteroscopy. (A) Clinical pregnancy rate. (B) Live birth rate.df: Degree of freedom; M-H: Mantel-Haenszel; RCT: randomized controlled trial.

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  Figure 4. Meta-analysis of the miscarriage rate.df: Degree of freedom; M-H: Mantel-Haenszel; RCT: randomized controlled trial.

Reference

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