MUNICH – Routinely performed hysteroscopy proved unable to increase the live-birth rate from in vitro fertilization in women who had two to four prior miscarriages after in vitro fertilization, according to results from a multicenter, controlled trial of 656 women.
Based on these findings, hysteroscopy should be limited to women with either a clinical indication or evidence of a uterine abnormality seen on transvaginal ultrasonography. Clinicians should not perform hysteroscopy in all women with a miscarriage history unless they have a reason to suspect that such an abnormality exists, said Dr. Tarek El-Toukhy in a video interview during the annual meeting of the European Society of Human Reproduction and Embryology.
Prior to this trial, some experts had hope that routine hysteroscopy could boost the live-birth rate following in vitro fertilization by 20%, 30%, or more, said Dr. El-Toukhy, a gynecologist at Guy’s and St. Thomas’ Hospital in London. But the finding that routine hysteroscopy failed to provide any benefit suggested that embryonic factors are more important than uterine factors for explaining the serial miscarriages in these women who have no clinical or ultrasound indication of a uterine problem.
Karl Storz supplied the hysteroscopy devices used in the study and training in their use. Dr. El-Toukhy said that he and his associates had no other disclosures.
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