Document Detail


The effectiveness of hysteroscopy in improving pregnancy rates in subfertile women without other gynaecological symptoms: a systematic review.
MedLine Citation:
PMID:  19744944     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Jan Bosteels; Steven Weyers; Patrick Puttemans; Costas Panayotidis; Bruno Van Herendael; Victor Gomel; Ben W J Mol; Chantal Mathieu; Thomas D'Hooghe
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Human reproduction update     Volume:  16     ISSN:  1460-2369     ISO Abbreviation:  Hum. Reprod. Update     Publication Date:    2010 Jan-Feb
Date Detail:
Created Date:  2009-12-16     Completed Date:  2010-02-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9507614     Medline TA:  Hum Reprod Update     Country:  England    
Other Details:
Languages:  eng     Pagination:  1-11     Citation Subset:  IM    
Affiliation:
Department of Obstetrics and Gynaecology, Imeldahospital, Bonheiden, Belgium. jan.bosteels@imelda.be
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MeSH Terms
Descriptor/Qualifier:
Female
Fertilization in Vitro
Humans
Hysteroscopy*
Infertility, Female / surgery*
Leiomyoma / surgery
Polyps / pathology,  surgery
Pregnancy
Pregnancy Rate
Randomized Controlled Trials as Topic
Tissue Adhesions / surgery
Treatment Outcome
Uterine Diseases / surgery

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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