THE ROLE OF HYSTEROSCOPIC METROPLASTY PRIOR TO IVF

Introduction: With regard to hysteroscopy and IVF, the role of office hysteroscopy in the work-up of infertile patients and within an IVF programme is still unclear. Physicians have differing points of view as to the use of hysteroscopy: actually some believe that it is not useful, others feel it should be applied as a routine test in all cases, whereas others maintain it should be performed only with ultrasound or in the treatment of HSGpositive cases or after failure of previous IVF cycles. The aim of this study was to demonstrate the usefulness of diagnostic and operative hysteroscopy in the diagnosis and treatment of uterine malformations before an IVF programme. Materials and Methods: A total of 385 patients who had undergone two or more failed IVF embryo transfer cycles were prospectively randomized into three groups. Group I (n = 202) patients had normal uterine cavity at the office hysteroscopic evaluation; group II (n = 102) patients had septate uterus and underwent to hysteroscopic metroplasty before further IVF cycles; group III (n = 81) patients had septate uterus and followed a new IVF programme, without hysteroscopic surgery. Results: The clinical pregnancy rate was dramatically higher in patients in group II (40.1%) in comparison with group I (23.7%; P 0.004) and group III (18.5%; P 0.001). Similar results were obtained in the three groups in terms of spontaneous abortion, with a clear advantage for patients who underwent the hysteroscopic surgery. Conclusions: These data strongly suggest that hysteroscopic metroplasty should be performed in all women with longstanding unexplained infertility and particularly in those women for whom assisted conception is being contemplated.