Document Detail

Should Diagnostic Hysteroscopy be Performed Before In Vitro Fertilization-Embryo Transfer?
MedLine Citation:
PMID:  22935306     Owner:  NLM     Status:  In-Data-Review    
The role of routine uterine cavity evaluation before an in vitro fertilization-embryo transfer (IVF-ET) cycle has not been uniformly accepted. Published trials have demonstrated a relatively high incidence of cavitary abnormalities diagnosed at outpatient hysteroscopy in patients with previous IVF-ET cycle failure, the correction of which markedly improves outcomes. The value of performing this procedure before an initial cycle in patients without previous implantation failure has not been definitively confirmed in prospective randomized trials, but would seem logical in an effort to minimize the number of cycles a patient must undergo. The incidence of cavitary abnormalities in this population varies. One large series has reported a 22.9% incidence of endometrial cavitary abnormalities diagnosed at pre-cycle office hysteroscopy in this patient group. Hysterosalpingography and baseline transvaginal ultrasonography are insufficiently sensitive alternatives. Sonohysterography with infusion of saline solution, in particular with 3-dimensional technology, may be a reasonable alternative to diagnostic hysteroscopy, although relatively few well-designed trials have addressed this issue. There are an insufficient number of prospective randomized trials to clearly demonstrate that surgical removal of all abnormalities improves IVF-ET outcome. However, investigators suggest a benefit for resection of submucosal leiomyomas, adhesions, and at least a subset of polyps. Appropriately designed trials are required before a definitive recommendation can be made.
Eric S Surrey
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of minimally invasive gynecology     Volume:  19     ISSN:  1553-4669     ISO Abbreviation:  J Minim Invasive Gynecol     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-08-31     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101235322     Medline TA:  J Minim Invasive Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  643-6     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 AAGL. Published by Elsevier Inc. All rights reserved.
Colorado Center for Reproductive Medicine, Lone Tree, Colorado.
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