Hysteroscopic Evaluation of The Uterine Cavity After Intracytoplasmic Sperm Injection and Embryo Transfer Failure: Is It Rewarding?

Objective: This study was performed to evaluate the role of hysteroscopy and directed biopsy in women after intracytoplasmic sperm injection (ICSI) and embryo transfer failure despite transfer of good-quality embryos. Materials and Methods: One hundred and twenty eighty women who failed to conceive after one trial of Intracytoplasmic sperm injection and embryo transfer due to male factor infertility despite transfer of good-quality embryos and met the inclusion criteria and completed the follow up period, were recruited in the study. All patients were subjected to diagnostic hysteroscopy with directed biopsy and any intrauterine abnormalities were corrected accordingly. Postoperative follow up was done monthly for a period of one year to detect pregnancy either spontaneous or after assisted trials. Results: Twenty five percent of patients demonstrated abnormal hysteroscopic findings. Uterine adhesion was the most common anatomical abnormalities and represented 10.2% of the patients. However, hyperplasic endometrium was the most common histopathological abnormalities and represented 3.9% of the patients. The clinical pregnancy rate was significantly higher in the operative hysteroscopy group (60%) when compared to the non-intervention diagnostic hysteroscopy group (14.3%). Conclusion: Hysteroscopic evaluation of the uterine cavity should be an essential step before a second trial of ICSI.