Efficacy of Hysteroscopy in Improving Fertility Outcomes in Assisted Reproductive Techniques

Objectives Successful outcomes in assisted reproductive technologies (ART) depend on three interrelated factors: a high-quality embryo, a structurally and functionally optimal uterine cavity, and a receptive endometrium. While embryo quality has traditionally been the principal focus, growing evidence suggests that undiagnosed or untreated intrauterine pathologies—such as congenital uterine anomalies or chronic endometritis—may compromise implantation and pregnancy success. To provide a comprehensive review of the role of hysteroscopy, in combination with advanced imaging modalities (notably three-dimensional ultrasound [3D USG]), in optimising fertility outcomes for patients undergoing ART. Material and Methods Literature was evaluated to summarise the diagnostic and therapeutic utility of hysteroscopy, its synergy with imaging techniques (3D USG, saline infusion sonography [SIS]), and its effects on key reproductive endpoints. Particular emphasis was placed on its ability to directly visualise and treat pathologies in a single procedure and its influence on clinical pregnancy rates (CPR) and live birth rates (LBR). Results Hysteroscopy, often performed as an office-based procedure without general anaesthesia, demonstrated notable advantages: direct visualisation of the uterine cavity, real-time characterisation of lesions, and immediate therapeutic intervention. When combined with 3D USG, which offers high specificity for diagnosing uterine anomalies and precise measurement of cavity dimensions, hysteroscopy further refines diagnostic accuracy and management. Meta-analyses and cohort studies reported improved CPR and LBR in patients undergoing hysteroscopic evaluation, particularly in those with recurrent implantation failure or suspected uterine abnormalities. Conclusion Hysteroscopy serves as a critical ‘bridge’ between imaging and intervention, enhancing the management of intrauterine pathologies that may hinder ART outcomes. Future randomised controlled trials are needed to clarify the role of routine hysteroscopic assessment in broader patient populations and to refine guidelines for integrating hysteroscopy into standard fertility workups.