Comparison of Hysteroscopy Findings and Outcomes between Pre-in vitro- fertilization (IVF) and Non-IVF Women with Infertility

A bstract Introduction: Hysteroscopy remains the gold standard in the diagnosis of endometrial pathologies; however, the benefit of routine hysteroscopy before in vitro -fertilization (IVF) is controversial. Objectives: To compare findings between pre-IVF and non-IVF patients and also to determine the benefit of routine hysteroscopy before a first IVF cycle. Materials and Methods: A retrospective study of hysteroscopy procedures was performed between 2019 and 2023. The case records of 101 patients, 60 pre-IVF (cases) and 41 non-IVF (controls), were extracted using a proforma designed by the authors. The independent-sample t test was used to compare the means of groups studied, while the chi-square test was used to compare categorical variables. The level of statistical significance was set at P < 0.05. Results: The pre-IVF patients had undergone significantly more diagnostic procedures ( P = 0.001), combinations of hysteroscopy with laparoscopy ( P = 0.011) and findings with potential to improve the IVF outcomes ( P = 0.007) when compared to the non-IVF patients. The repeat IVF patients had significantly more endometrial pathologies ( P = 0.019, OR = 3.64, CI = 1.23–10.73) and requirement for operative procedures ( P = 0.012, OR = 2.16, CI = 1.08–4.33), compared to the first cycle IVF patients. The duration of hysteroscopy ( P = 0.170), intraoperative complications ( P = 0.433), and duration of hospitalization ( P = 1.000) were similar. Conclusion: The pre-IVF patients have some significant findings than non-IVF controls suggesting that hysteroscopic evaluation/intervention has the potential to improve IVF outcomes. Furthermore, the pre-IVF patients opting for a repeat cycle had more significant endometrial pathologies, whose treatment could improve IVF outcomes. Hysteroscopy may improve the evaluation of the patients with failed IVF, however a risk-based approach should be applied to first IVF cycle patients.