Page 4 - World Journal of Laparoscopic Surgery

Bamgbopa Tajudeen Kehinde

literature included; year of publication (publications more than hysteroscopy followed by IVF cycle. The implantation and
10 years old were largely ignored), types of study (preference pregnancy rates were similar between the groups. Clinical
for systematic reviews and randomized controlled studies), outcomes in patients with repeated IVF failure who had
methods of analysis (statistical or nonstatistical) and Institution hysteroscopy with no pathology compared with those who
where studies were done (specialized fertility and endoscopic had pathology, did not show any statistical differences. 10
units). Olivera et al and La Sala et al prospectively studied 55 and
100 post-IVF patient undergoing diagnostic hysteroscopy

FINDINGS AND DISCUSSION respectively. Of the 55 in the Olivera series, 25 (45%) had
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abnormalities which were treated. Eighteen percent of patients
Prevalence of Uterine Anomalies in the La Sala series had uterine anomalies. 11
In a randomized controlled study by Rama Raju and
The prevalence of uterine anomalies in patient undergoing IVF colleagues, 520 patient Pre-IVF patients were randomized into a
varies widely depending on the study population. A review by hysteroscopy and a no- hysteroscopy group. Group I (n = 265)
Bozdag et al revealed rates of 18-50% in patients undergoing without office hysteroscopy. Group II (n = 255) had office
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IVF and 40-43% in patients with known IVF failures. Hucke hysteroscopy and was subclassified into group II a and group
and colleagues in a review found 20% anomaly rates among II b. Group II a (n = 160) had normal hysteroscopic findings
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infertile women. Four prospective studies were reviewed with whereas group II b (n = 95) had abnormal office hysteroscopy
findings of 38% by Hinckley and Milki and 40.6% by Lorusso findings, which were corrected at the same time. There was no
et al in pre-IVF treatment women while rates of 18% La Sala difference in the mean number of oocytes retrieved, fertilization
et al1998, and 45% Olivera et al, in women with recurrent rate, and number of embryos transferred among the patients in
implantation failure (RIF). 3,10-12 Endometrial polyps and uterine different groups. Statistically significant difference was
septum seem to be more frequent in our infertile patients than in observed in terms of clinical pregnancy rates between group I
the general population. 13 and group II a (26.2 and 44.44%, P < 0.05), and group I and
The prevalence figures revealed from this review are quite group II b (26.2 and 39.55%, P < 0.05), respectively. 14
significant and are a strong argument for a more extensive Similarly, a RCT of Post-IVF failure patients were carried
assessment of the uterine cavity as part of the primary out by Demirol and Gurgan. Four hundred and twenty-one
assessment of patients planned for assisted reproduction.
patients who had undergone two or more failed IVF-embryo
transfer cycles were prospectively randomized into two groups.
Diagnostic Hysteroscopy: Pre-IVF Treatment and
Post-IVF Failures group I (n = 211) did not have office hysteroscopic evaluation,
group II (n = 210) had office hysteroscopy. The patients who
There is increasing use of diagnostic hysteroscopy be as part had normal hysteroscopic findings were included in group IIa
of routine investigation of infertile couple undergoing IVF. 6 (n = 154) and patients who had abnormal hysteroscopic findings
The accepted practice in the past had been the review of uterine were included in group IIb (n = 56). Intrauterine lesions
cavity by Hysterosalpingography with a resort to diagnostic diagnosed were operated during the office procedure. Fifty-six
hysteroscopy only after recurrent implantation failures (RIF). (26%) patients in group II had intrauterine pathologies and the
Pre-IVF hysteroscopy was done only when specifically indicate treatment was performed at the same time. No difference existed
Economic considerations and lack of expertise is thought to in the mean number of oocyte retrieved, fertilization rate, and
contribute to the reluctance to use hysteroscopy as primary number of embryos transferred or first trimester abortion rates
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investigative tool. A number of prospective studies, 2 RCTs among the patients in groups. Clinical pregnancy rates in
and a systematic review were reviewed under this heading. group I, group IIa and group IIb were 21.6%, 32.5% and 30.4%
A prospective study of 1000 patients undergoing pre-IVF respectively. There was a significant difference in the clinical
hysteroscopy by Campo et al revealed 62% had a normal uterine pregnancy rates between patients in group I and group IIa
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cavity. Thirty-two percent had endometrial polyps. Other (21.6% and 32.5%, P = 0.044, respectively) and group I and
pathology included submucous fibroids (3%), intrauterine group IIb (21.6% and 30.4%, P = 0.044, respectively). There was
adhesions (3%), polypoid endometrium (0.9%), septum (0.5%) no significant difference in the clinical pregnancy rate of patients
retained products of conception (0.3%), and bicornuate uterus in groups IIa and IIb. Patients with normal hysterosalpingo-
(0.3%). 3 graphy but recurrent IVF-embryo transfer failure should be
DePlacido et al in a prospective series of 950 patients evaluated prior to commencing IVF-embryo transfer cycle to
comparing minihysteroscope (n = 602) with 5 mm hysteroscope improve the clinical pregnancy rate. 15
(n = 348) in an office setting. There was no difference in cavity A systematic review of studies evaluating the influence of
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finding in the two groups. In the prospective series by Lorusso outpatient (office) hysteroscopy on the outcome of the
et al, 555 pre-IVF and 311 Post-IVF Failure patients had subsequent IVF cycle was conducted by El Touchy.
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JAYPEE