The role of diagnostic hysteroscopy and endometrial biopsy in assisted reproductive technologies

Objective: To study the incidence of unsuspected endouterine abnormalities in patients for whom IVF-ET repeatedly fails. Design: Prospective study. Setting: Infertility Unit of the Department of Obstetrics and Gynecology, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. Patient(s): One hundred patients for whom two IVF-ET cycles failed in which ≥2 good-quality embryos were transferred. Intervention(s): In-office diagnostic hysteroscopy and endometrial biopsy. Main Outcome Measure(s): Relation between IVF-ET failure and unsuspected endouterine abnormalities. Result(s): In 18 patients, hysteroscopy showed an important unsuspected endouterine abnormality. Fifteen of these patients did not become pregnant after IVF-ET, and 3 became pregnant but had a spontaneous abortion. Histologic examination of the endometrium revealed chronic endometritis in 1 patient and tuberculous endometritis in another. Conclusion(s): Previous studies have reported that the incidence of endouterine abnormalities is high in patients undergoing IVF-ET. Our data confirm the previous reports and lead us to conclude that diagnostic hysteroscopy should be performed on all patients before they undergo IVF-ET.