Role of routine hysteroscopy in previous failed ICSI: a continuous clinical dilemma

Abstract

Abstract Background The benefit of hysteroscopy could extend beyond the treatment of intrauterine abnormalities. Irrigation of the cavity with saline may have a beneficial effect on implantation and pregnancy rates, since saline mechanically washes harmful anti-adhesive glycoprotein molecules on the endometrial surface involved in endometrial receptivity, i.e., cyclooxygenase-2 (COX-2), mucin-1 (MUC-1), and integrin. Objective The aim of this study is to evaluate the role and benefit of routine hysteroscopy prior to ICSI in women with previous failed ICSI. Patients and methods This prospective study has been carried out, at the outpatient clinic, on 100 women that have undergone hysteroscopy as a part of the infertility workup. Women were categorized into three groups according to the number of previous failed IVF/ICSI, once (n = 37), twice (n = 33), and thrice (n = 30). Results After analyzing the data, we found that hysteroscopy was associated with 39% overall clinical pregnancy rate in women with previous/repeat IVF/ICSI failure. Treatment of polyp was associated with 58.3% clinical pregnancy rate (NNT = 1.71). Treatment of intrauterine adhesions was associated with 16.7% clinical pregnancy rate (NNT = 6). Treatment of submucous myoma and uterine septum showed a 75% and 50% clinical pregnancy rate, respectively. Conclusion Hysteroscopic examination in women with previous failed ICSI may improve pregnancy rate even in the absence of uterine pathology. Consequently, hysteroscopy examination may be proposed as a routine step prior to ICSI in case of previous failure.