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European Society for Human Reproduction and Embryology (ESHRE): Annual Meeting
Routine hysteroscopy failed to aid recurrent miscarriages
MUNICH – Routine hysteroscopy and treatment of uterine abnormalities found by using it failed to improve the live-birth rate after in vitro fertilization in asymptomatic women with no ultrasound findings who already had failed two to four attempts at pregnancy and delivery with IVF, in a randomized, controlled trial of 656 women.
"Out-patient hysteroscopy cannot be routinely recommended after recurrent in vitro fertilization failure," concluded Dr. Tarek El-Toukhy at the annual meeting of the European Society of Human Reproduction and Embryology.
Based on these findings, hysteroscopy should be limited to women with clinical symptoms or ultrasound findings that suggest an abnormality in the uterine cavity, but hysteroscopy should not be performed routinely in all women who have a history of multiple miscarriages, said Dr. El-Toukhy, a gynecologist at Guy’s and St. Thomas’ Hospital in London.
The study results indicated that roughly one in nine of the enrolled women had a uterine abnormality that was detectable by hysteroscopy, but finding and correcting these problems had no effect on pregnancy outcomes.
Seeing these data, "I have the impression that [routine hysteroscopy] is of no use. The study was well done," commented Dr. Klaus Friese, a gynecologist and director of the Women’s Hospital of the University of Munich.
"When you see something unusual by ultrasound or if you suspect a problem, then you should do hysteroscopy, but not just because the women had three miscarriages when the ultrasound shows nothing," Dr. Friese said in an interview.
The findings also suggest that when multiple miscarriages occur following IVF, embryo factors are often involved rather than issues in the mother, said Dr. El-Toukhy. "Even when women had a uterine issue, treatment did not help. That lends more importance to embryo factors. Uterine factors can be important, but not as important as embryo factors" to explain multiple miscarriages following IVF, he said.
The TROPHY (Trial of Outpatient Hysteroscopy) study was run at eight centers in four European countries. The investigators randomized women who were younger than 38 years and who had a body mass index of less than 35 kg/m2, a history of two to four prior miscarriages following IVF, and a normal-appearing uterus when assessed by transvaginal ultrasonography. Woman randomized to routine hysteroscopy had the procedure done using a Campo Trophyscope marketed by Karl Storz. Uterine abnormalities found by routine hysteroscopy were treated when appropriate. All women enrolled then underwent ovarian stimulation and IVF using usual local protocols.
At the end of the study, the 332 women randomized to routine hysteroscopy with evaluable follow-up had a 39% pregnancy rate and a 30% live-birth rate, not statistically different from the 39% pregnancy rate and 29% live-birth rate seen among 324 evaluable women randomized to no hysteroscopy, Dr. El-Toukhy reported.
In the women randomized to routine hysteroscopy, 11% showed a significant abnormality on examination, including 15 women with an arcuate uterus, 11 women with endometrial polyps, and five women with a partial septum, as well as women with a few other less common abnormalities. Fifteen women underwent a surgical procedure to address abnormalities found by hysteroscopy. Hysteroscopy also found one or more "subtle" abnormalities in 13% of the examined women, a category for abnormalities of uncertain significance that included hypervascularization of the uterus (20 women) and mucosal elevation (13 women). None of the subtle abnormalities received treatment.
Prespecified analyses of the outcomes in the subgroup of women who had routine hysteroscopy showed no statistically significant differences in the pregnancy or live-birth rates of the women with or without significant uterine abnormalities identified by hysteroscopy or in the women with or without subtle uterine abnormalities, Dr. El-Toukhy said.
Karl Storz supplied the hysteroscopy devices used in the study and training in their use. Dr. El-Toukhy said that he and his associates had no other disclosures. Dr. Friese had no relevant disclosures.
On Twitter @mitchelzoler
MUNICH – Routine hysteroscopy and treatment of uterine abnormalities found by using it failed to improve the live-birth rate after in vitro fertilization in asymptomatic women with no ultrasound findings who already had failed two to four attempts at pregnancy and delivery with IVF, in a randomized, controlled trial of 656 women.
"Out-patient hysteroscopy cannot be routinely recommended after recurrent in vitro fertilization failure," concluded Dr. Tarek El-Toukhy at the annual meeting of the European Society of Human Reproduction and Embryology.
Based on these findings, hysteroscopy should be limited to women with clinical symptoms or ultrasound findings that suggest an abnormality in the uterine cavity, but hysteroscopy should not be performed routinely in all women who have a history of multiple miscarriages, said Dr. El-Toukhy, a gynecologist at Guy’s and St. Thomas’ Hospital in London.
The study results indicated that roughly one in nine of the enrolled women had a uterine abnormality that was detectable by hysteroscopy, but finding and correcting these problems had no effect on pregnancy outcomes.
Seeing these data, "I have the impression that [routine hysteroscopy] is of no use. The study was well done," commented Dr. Klaus Friese, a gynecologist and director of the Women’s Hospital of the University of Munich.
"When you see something unusual by ultrasound or if you suspect a problem, then you should do hysteroscopy, but not just because the women had three miscarriages when the ultrasound shows nothing," Dr. Friese said in an interview.
The findings also suggest that when multiple miscarriages occur following IVF, embryo factors are often involved rather than issues in the mother, said Dr. El-Toukhy. "Even when women had a uterine issue, treatment did not help. That lends more importance to embryo factors. Uterine factors can be important, but not as important as embryo factors" to explain multiple miscarriages following IVF, he said.
The TROPHY (Trial of Outpatient Hysteroscopy) study was run at eight centers in four European countries. The investigators randomized women who were younger than 38 years and who had a body mass index of less than 35 kg/m2, a history of two to four prior miscarriages following IVF, and a normal-appearing uterus when assessed by transvaginal ultrasonography. Woman randomized to routine hysteroscopy had the procedure done using a Campo Trophyscope marketed by Karl Storz. Uterine abnormalities found by routine hysteroscopy were treated when appropriate. All women enrolled then underwent ovarian stimulation and IVF using usual local protocols.
At the end of the study, the 332 women randomized to routine hysteroscopy with evaluable follow-up had a 39% pregnancy rate and a 30% live-birth rate, not statistically different from the 39% pregnancy rate and 29% live-birth rate seen among 324 evaluable women randomized to no hysteroscopy, Dr. El-Toukhy reported.
In the women randomized to routine hysteroscopy, 11% showed a significant abnormality on examination, including 15 women with an arcuate uterus, 11 women with endometrial polyps, and five women with a partial septum, as well as women with a few other less common abnormalities. Fifteen women underwent a surgical procedure to address abnormalities found by hysteroscopy. Hysteroscopy also found one or more "subtle" abnormalities in 13% of the examined women, a category for abnormalities of uncertain significance that included hypervascularization of the uterus (20 women) and mucosal elevation (13 women). None of the subtle abnormalities received treatment.
Prespecified analyses of the outcomes in the subgroup of women who had routine hysteroscopy showed no statistically significant differences in the pregnancy or live-birth rates of the women with or without significant uterine abnormalities identified by hysteroscopy or in the women with or without subtle uterine abnormalities, Dr. El-Toukhy said.
Karl Storz supplied the hysteroscopy devices used in the study and training in their use. Dr. El-Toukhy said that he and his associates had no other disclosures. Dr. Friese had no relevant disclosures.
On Twitter @mitchelzoler
MUNICH – Routine hysteroscopy and treatment of uterine abnormalities found by using it failed to improve the live-birth rate after in vitro fertilization in asymptomatic women with no ultrasound findings who already had failed two to four attempts at pregnancy and delivery with IVF, in a randomized, controlled trial of 656 women.
"Out-patient hysteroscopy cannot be routinely recommended after recurrent in vitro fertilization failure," concluded Dr. Tarek El-Toukhy at the annual meeting of the European Society of Human Reproduction and Embryology.
Based on these findings, hysteroscopy should be limited to women with clinical symptoms or ultrasound findings that suggest an abnormality in the uterine cavity, but hysteroscopy should not be performed routinely in all women who have a history of multiple miscarriages, said Dr. El-Toukhy, a gynecologist at Guy’s and St. Thomas’ Hospital in London.
The study results indicated that roughly one in nine of the enrolled women had a uterine abnormality that was detectable by hysteroscopy, but finding and correcting these problems had no effect on pregnancy outcomes.
Seeing these data, "I have the impression that [routine hysteroscopy] is of no use. The study was well done," commented Dr. Klaus Friese, a gynecologist and director of the Women’s Hospital of the University of Munich.
"When you see something unusual by ultrasound or if you suspect a problem, then you should do hysteroscopy, but not just because the women had three miscarriages when the ultrasound shows nothing," Dr. Friese said in an interview.
The findings also suggest that when multiple miscarriages occur following IVF, embryo factors are often involved rather than issues in the mother, said Dr. El-Toukhy. "Even when women had a uterine issue, treatment did not help. That lends more importance to embryo factors. Uterine factors can be important, but not as important as embryo factors" to explain multiple miscarriages following IVF, he said.
The TROPHY (Trial of Outpatient Hysteroscopy) study was run at eight centers in four European countries. The investigators randomized women who were younger than 38 years and who had a body mass index of less than 35 kg/m2, a history of two to four prior miscarriages following IVF, and a normal-appearing uterus when assessed by transvaginal ultrasonography. Woman randomized to routine hysteroscopy had the procedure done using a Campo Trophyscope marketed by Karl Storz. Uterine abnormalities found by routine hysteroscopy were treated when appropriate. All women enrolled then underwent ovarian stimulation and IVF using usual local protocols.
At the end of the study, the 332 women randomized to routine hysteroscopy with evaluable follow-up had a 39% pregnancy rate and a 30% live-birth rate, not statistically different from the 39% pregnancy rate and 29% live-birth rate seen among 324 evaluable women randomized to no hysteroscopy, Dr. El-Toukhy reported.
In the women randomized to routine hysteroscopy, 11% showed a significant abnormality on examination, including 15 women with an arcuate uterus, 11 women with endometrial polyps, and five women with a partial septum, as well as women with a few other less common abnormalities. Fifteen women underwent a surgical procedure to address abnormalities found by hysteroscopy. Hysteroscopy also found one or more "subtle" abnormalities in 13% of the examined women, a category for abnormalities of uncertain significance that included hypervascularization of the uterus (20 women) and mucosal elevation (13 women). None of the subtle abnormalities received treatment.
Prespecified analyses of the outcomes in the subgroup of women who had routine hysteroscopy showed no statistically significant differences in the pregnancy or live-birth rates of the women with or without significant uterine abnormalities identified by hysteroscopy or in the women with or without subtle uterine abnormalities, Dr. El-Toukhy said.
Karl Storz supplied the hysteroscopy devices used in the study and training in their use. Dr. El-Toukhy said that he and his associates had no other disclosures. Dr. Friese had no relevant disclosures.
On Twitter @mitchelzoler
AT ESHRE 2014
Key clinical point: Routine hysteroscopy prior to in vitro fertilization did not improve IVF outcomes in asymptomatic women with two to four prior miscarriages.
Major finding: The live-birth rate after IVF was 30% in women undergoing routine hysteroscopy and 29% in those with no hysteroscopy.
Data source: TROPHY, a prospective, randomized, controlled trial with 656 evaluable women treated at eight centers in four European countries.
Disclosures: Karl Storz supplied the hysteroscopy devices used in the study and training in their use. Dr. El-Toukhy said that he and his associates had no other disclosures.
Routine hysteroscopy failed to aid recurrent miscarriages
MUNICH – Routine hysteroscopy and treatment of uterine abnormalities found by using it failed to improve the live-birth rate after in vitro fertilization in asymptomatic women with no ultrasound findings who already had failed two to four attempts at pregnancy and delivery with IVF, in a randomized, controlled trial of 656 women.
"Out-patient hysteroscopy cannot be routinely recommended after recurrent in vitro fertilization failure," concluded Dr. Tarek El-Toukhy at the annual meeting of the European Society of Human Reproduction and Embryology.
Based on these findings, hysteroscopy should be limited to women with clinical symptoms or ultrasound findings that suggest an abnormality in the uterine cavity, but hysteroscopy should not be performed routinely in all women who have a history of multiple miscarriages, said Dr. El-Toukhy, a gynecologist at Guy’s and St. Thomas’ Hospital in London.
The study results indicated that roughly one in nine of the enrolled women had a uterine abnormality that was detectable by hysteroscopy, but finding and correcting these problems had no effect on pregnancy outcomes.
Seeing these data, "I have the impression that [routine hysteroscopy] is of no use. The study was well done," commented Dr. Klaus Friese, a gynecologist and director of the Women’s Hospital of the University of Munich.
"When you see something unusual by ultrasound or if you suspect a problem, then you should do hysteroscopy, but not just because the women had three miscarriages when the ultrasound shows nothing," Dr. Friese said in an interview.
The findings also suggest that when multiple miscarriages occur following IVF, embryo factors are often involved rather than issues in the mother, said Dr. El-Toukhy. "Even when women had a uterine issue, treatment did not help. That lends more importance to embryo factors. Uterine factors can be important, but not as important as embryo factors" to explain multiple miscarriages following IVF, he said.
The TROPHY (Trial of Outpatient Hysteroscopy) study was run at eight centers in four European countries. The investigators randomized women who were younger than 38 years and who had a body mass index of less than 35 kg/m2, a history of two to four prior miscarriages following IVF, and a normal-appearing uterus when assessed by transvaginal ultrasonography. Woman randomized to routine hysteroscopy had the procedure done using a Campo Trophyscope marketed by Karl Storz. Uterine abnormalities found by routine hysteroscopy were treated when appropriate. All women enrolled then underwent ovarian stimulation and IVF using usual local protocols.
At the end of the study, the 332 women randomized to routine hysteroscopy with evaluable follow-up had a 39% pregnancy rate and a 30% live-birth rate, not statistically different from the 39% pregnancy rate and 29% live-birth rate seen among 324 evaluable women randomized to no hysteroscopy, Dr. El-Toukhy reported.
In the women randomized to routine hysteroscopy, 11% showed a significant abnormality on examination, including 15 women with an arcuate uterus, 11 women with endometrial polyps, and five women with a partial septum, as well as women with a few other less common abnormalities. Fifteen women underwent a surgical procedure to address abnormalities found by hysteroscopy. Hysteroscopy also found one or more "subtle" abnormalities in 13% of the examined women, a category for abnormalities of uncertain significance that included hypervascularization of the uterus (20 women) and mucosal elevation (13 women). None of the subtle abnormalities received treatment.
Prespecified analyses of the outcomes in the subgroup of women who had routine hysteroscopy showed no statistically significant differences in the pregnancy or live-birth rates of the women with or without significant uterine abnormalities identified by hysteroscopy or in the women with or without subtle uterine abnormalities, Dr. El-Toukhy said.
Karl Storz supplied the hysteroscopy devices used in the study and training in their use. Dr. El-Toukhy said that he and his associates had no other disclosures. Dr. Friese had no relevant disclosures.
On Twitter @mitchelzoler
MUNICH – Routine hysteroscopy and treatment of uterine abnormalities found by using it failed to improve the live-birth rate after in vitro fertilization in asymptomatic women with no ultrasound findings who already had failed two to four attempts at pregnancy and delivery with IVF, in a randomized, controlled trial of 656 women.
"Out-patient hysteroscopy cannot be routinely recommended after recurrent in vitro fertilization failure," concluded Dr. Tarek El-Toukhy at the annual meeting of the European Society of Human Reproduction and Embryology.
Based on these findings, hysteroscopy should be limited to women with clinical symptoms or ultrasound findings that suggest an abnormality in the uterine cavity, but hysteroscopy should not be performed routinely in all women who have a history of multiple miscarriages, said Dr. El-Toukhy, a gynecologist at Guy’s and St. Thomas’ Hospital in London.
The study results indicated that roughly one in nine of the enrolled women had a uterine abnormality that was detectable by hysteroscopy, but finding and correcting these problems had no effect on pregnancy outcomes.
Seeing these data, "I have the impression that [routine hysteroscopy] is of no use. The study was well done," commented Dr. Klaus Friese, a gynecologist and director of the Women’s Hospital of the University of Munich.
"When you see something unusual by ultrasound or if you suspect a problem, then you should do hysteroscopy, but not just because the women had three miscarriages when the ultrasound shows nothing," Dr. Friese said in an interview.
The findings also suggest that when multiple miscarriages occur following IVF, embryo factors are often involved rather than issues in the mother, said Dr. El-Toukhy. "Even when women had a uterine issue, treatment did not help. That lends more importance to embryo factors. Uterine factors can be important, but not as important as embryo factors" to explain multiple miscarriages following IVF, he said.
The TROPHY (Trial of Outpatient Hysteroscopy) study was run at eight centers in four European countries. The investigators randomized women who were younger than 38 years and who had a body mass index of less than 35 kg/m2, a history of two to four prior miscarriages following IVF, and a normal-appearing uterus when assessed by transvaginal ultrasonography. Woman randomized to routine hysteroscopy had the procedure done using a Campo Trophyscope marketed by Karl Storz. Uterine abnormalities found by routine hysteroscopy were treated when appropriate. All women enrolled then underwent ovarian stimulation and IVF using usual local protocols.
At the end of the study, the 332 women randomized to routine hysteroscopy with evaluable follow-up had a 39% pregnancy rate and a 30% live-birth rate, not statistically different from the 39% pregnancy rate and 29% live-birth rate seen among 324 evaluable women randomized to no hysteroscopy, Dr. El-Toukhy reported.
In the women randomized to routine hysteroscopy, 11% showed a significant abnormality on examination, including 15 women with an arcuate uterus, 11 women with endometrial polyps, and five women with a partial septum, as well as women with a few other less common abnormalities. Fifteen women underwent a surgical procedure to address abnormalities found by hysteroscopy. Hysteroscopy also found one or more "subtle" abnormalities in 13% of the examined women, a category for abnormalities of uncertain significance that included hypervascularization of the uterus (20 women) and mucosal elevation (13 women). None of the subtle abnormalities received treatment.
Prespecified analyses of the outcomes in the subgroup of women who had routine hysteroscopy showed no statistically significant differences in the pregnancy or live-birth rates of the women with or without significant uterine abnormalities identified by hysteroscopy or in the women with or without subtle uterine abnormalities, Dr. El-Toukhy said.
Karl Storz supplied the hysteroscopy devices used in the study and training in their use. Dr. El-Toukhy said that he and his associates had no other disclosures. Dr. Friese had no relevant disclosures.
On Twitter @mitchelzoler
MUNICH – Routine hysteroscopy and treatment of uterine abnormalities found by using it failed to improve the live-birth rate after in vitro fertilization in asymptomatic women with no ultrasound findings who already had failed two to four attempts at pregnancy and delivery with IVF, in a randomized, controlled trial of 656 women.
"Out-patient hysteroscopy cannot be routinely recommended after recurrent in vitro fertilization failure," concluded Dr. Tarek El-Toukhy at the annual meeting of the European Society of Human Reproduction and Embryology.
Based on these findings, hysteroscopy should be limited to women with clinical symptoms or ultrasound findings that suggest an abnormality in the uterine cavity, but hysteroscopy should not be performed routinely in all women who have a history of multiple miscarriages, said Dr. El-Toukhy, a gynecologist at Guy’s and St. Thomas’ Hospital in London.
The study results indicated that roughly one in nine of the enrolled women had a uterine abnormality that was detectable by hysteroscopy, but finding and correcting these problems had no effect on pregnancy outcomes.
Seeing these data, "I have the impression that [routine hysteroscopy] is of no use. The study was well done," commented Dr. Klaus Friese, a gynecologist and director of the Women’s Hospital of the University of Munich.
"When you see something unusual by ultrasound or if you suspect a problem, then you should do hysteroscopy, but not just because the women had three miscarriages when the ultrasound shows nothing," Dr. Friese said in an interview.
The findings also suggest that when multiple miscarriages occur following IVF, embryo factors are often involved rather than issues in the mother, said Dr. El-Toukhy. "Even when women had a uterine issue, treatment did not help. That lends more importance to embryo factors. Uterine factors can be important, but not as important as embryo factors" to explain multiple miscarriages following IVF, he said.
The TROPHY (Trial of Outpatient Hysteroscopy) study was run at eight centers in four European countries. The investigators randomized women who were younger than 38 years and who had a body mass index of less than 35 kg/m2, a history of two to four prior miscarriages following IVF, and a normal-appearing uterus when assessed by transvaginal ultrasonography. Woman randomized to routine hysteroscopy had the procedure done using a Campo Trophyscope marketed by Karl Storz. Uterine abnormalities found by routine hysteroscopy were treated when appropriate. All women enrolled then underwent ovarian stimulation and IVF using usual local protocols.
At the end of the study, the 332 women randomized to routine hysteroscopy with evaluable follow-up had a 39% pregnancy rate and a 30% live-birth rate, not statistically different from the 39% pregnancy rate and 29% live-birth rate seen among 324 evaluable women randomized to no hysteroscopy, Dr. El-Toukhy reported.
In the women randomized to routine hysteroscopy, 11% showed a significant abnormality on examination, including 15 women with an arcuate uterus, 11 women with endometrial polyps, and five women with a partial septum, as well as women with a few other less common abnormalities. Fifteen women underwent a surgical procedure to address abnormalities found by hysteroscopy. Hysteroscopy also found one or more "subtle" abnormalities in 13% of the examined women, a category for abnormalities of uncertain significance that included hypervascularization of the uterus (20 women) and mucosal elevation (13 women). None of the subtle abnormalities received treatment.
Prespecified analyses of the outcomes in the subgroup of women who had routine hysteroscopy showed no statistically significant differences in the pregnancy or live-birth rates of the women with or without significant uterine abnormalities identified by hysteroscopy or in the women with or without subtle uterine abnormalities, Dr. El-Toukhy said.
Karl Storz supplied the hysteroscopy devices used in the study and training in their use. Dr. El-Toukhy said that he and his associates had no other disclosures. Dr. Friese had no relevant disclosures.
On Twitter @mitchelzoler
AT ESHRE 2014
Key clinical point: Routine hysteroscopy prior to in vitro fertilization did not improve IVF outcomes in asymptomatic women with two to four prior miscarriages.
Major finding: The live-birth rate after IVF was 30% in women undergoing routine hysteroscopy and 29% in those with no hysteroscopy.
Data source: TROPHY, a prospective, randomized, controlled trial with 656 evaluable women treated at eight centers in four European countries.
Disclosures: Karl Storz supplied the hysteroscopy devices used in the study and training in their use. Dr. El-Toukhy said that he and his associates had no other disclosures.
VIDEO: Routine hysteroscopy found unnecessary after multiple miscarriages
MUNICH – Routinely performed hysteroscopy proved unable to increase the live-birth rate from in vitro fertilization in women who had two to four prior miscarriages after in vitro fertilization, according to results from a multicenter, controlled trial of 656 women.
Based on these findings, hysteroscopy should be limited to women with either a clinical indication or evidence of a uterine abnormality seen on transvaginal ultrasonography. Clinicians should not perform hysteroscopy in all women with a miscarriage history unless they have a reason to suspect that such an abnormality exists, said Dr. Tarek El-Toukhy in a video interview during the annual meeting of the European Society of Human Reproduction and Embryology.
Prior to this trial, some experts had hope that routine hysteroscopy could boost the live-birth rate following in vitro fertilization by 20%, 30%, or more, said Dr. El-Toukhy, a gynecologist at Guy’s and St. Thomas’ Hospital in London. But the finding that routine hysteroscopy failed to provide any benefit suggested that embryonic factors are more important than uterine factors for explaining the serial miscarriages in these women who have no clinical or ultrasound indication of a uterine problem.
Karl Storz supplied the hysteroscopy devices used in the study and training in their use. Dr. El-Toukhy said that he and his associates had no other disclosures.
On Twitter @mitchelzoler
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
MUNICH – Routinely performed hysteroscopy proved unable to increase the live-birth rate from in vitro fertilization in women who had two to four prior miscarriages after in vitro fertilization, according to results from a multicenter, controlled trial of 656 women.
Based on these findings, hysteroscopy should be limited to women with either a clinical indication or evidence of a uterine abnormality seen on transvaginal ultrasonography. Clinicians should not perform hysteroscopy in all women with a miscarriage history unless they have a reason to suspect that such an abnormality exists, said Dr. Tarek El-Toukhy in a video interview during the annual meeting of the European Society of Human Reproduction and Embryology.
Prior to this trial, some experts had hope that routine hysteroscopy could boost the live-birth rate following in vitro fertilization by 20%, 30%, or more, said Dr. El-Toukhy, a gynecologist at Guy’s and St. Thomas’ Hospital in London. But the finding that routine hysteroscopy failed to provide any benefit suggested that embryonic factors are more important than uterine factors for explaining the serial miscarriages in these women who have no clinical or ultrasound indication of a uterine problem.
Karl Storz supplied the hysteroscopy devices used in the study and training in their use. Dr. El-Toukhy said that he and his associates had no other disclosures.
On Twitter @mitchelzoler
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
MUNICH – Routinely performed hysteroscopy proved unable to increase the live-birth rate from in vitro fertilization in women who had two to four prior miscarriages after in vitro fertilization, according to results from a multicenter, controlled trial of 656 women.
Based on these findings, hysteroscopy should be limited to women with either a clinical indication or evidence of a uterine abnormality seen on transvaginal ultrasonography. Clinicians should not perform hysteroscopy in all women with a miscarriage history unless they have a reason to suspect that such an abnormality exists, said Dr. Tarek El-Toukhy in a video interview during the annual meeting of the European Society of Human Reproduction and Embryology.
Prior to this trial, some experts had hope that routine hysteroscopy could boost the live-birth rate following in vitro fertilization by 20%, 30%, or more, said Dr. El-Toukhy, a gynecologist at Guy’s and St. Thomas’ Hospital in London. But the finding that routine hysteroscopy failed to provide any benefit suggested that embryonic factors are more important than uterine factors for explaining the serial miscarriages in these women who have no clinical or ultrasound indication of a uterine problem.
Karl Storz supplied the hysteroscopy devices used in the study and training in their use. Dr. El-Toukhy said that he and his associates had no other disclosures.
On Twitter @mitchelzoler
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT ESHRE 2014
VIDEO: Routine hysteroscopy found unnecessary after multiple miscarriages
MUNICH – Routinely performed hysteroscopy proved unable to increase the live-birth rate from in vitro fertilization in women who had two to four prior miscarriages after in vitro fertilization, according to results from a multicenter, controlled trial of 656 women.
Based on these findings, hysteroscopy should be limited to women with either a clinical indication or evidence of a uterine abnormality seen on transvaginal ultrasonography. Clinicians should not perform hysteroscopy in all women with a miscarriage history unless they have a reason to suspect that such an abnormality exists, said Dr. Tarek El-Toukhy in a video interview during the annual meeting of the European Society of Human Reproduction and Embryology.
Prior to this trial, some experts had hope that routine hysteroscopy could boost the live-birth rate following in vitro fertilization by 20%, 30%, or more, said Dr. El-Toukhy, a gynecologist at Guy’s and St. Thomas’ Hospital in London. But the finding that routine hysteroscopy failed to provide any benefit suggested that embryonic factors are more important than uterine factors for explaining the serial miscarriages in these women who have no clinical or ultrasound indication of a uterine problem.
Karl Storz supplied the hysteroscopy devices used in the study and training in their use. Dr. El-Toukhy said that he and his associates had no other disclosures.
On Twitter @mitchelzoler
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
MUNICH – Routinely performed hysteroscopy proved unable to increase the live-birth rate from in vitro fertilization in women who had two to four prior miscarriages after in vitro fertilization, according to results from a multicenter, controlled trial of 656 women.
Based on these findings, hysteroscopy should be limited to women with either a clinical indication or evidence of a uterine abnormality seen on transvaginal ultrasonography. Clinicians should not perform hysteroscopy in all women with a miscarriage history unless they have a reason to suspect that such an abnormality exists, said Dr. Tarek El-Toukhy in a video interview during the annual meeting of the European Society of Human Reproduction and Embryology.
Prior to this trial, some experts had hope that routine hysteroscopy could boost the live-birth rate following in vitro fertilization by 20%, 30%, or more, said Dr. El-Toukhy, a gynecologist at Guy’s and St. Thomas’ Hospital in London. But the finding that routine hysteroscopy failed to provide any benefit suggested that embryonic factors are more important than uterine factors for explaining the serial miscarriages in these women who have no clinical or ultrasound indication of a uterine problem.
Karl Storz supplied the hysteroscopy devices used in the study and training in their use. Dr. El-Toukhy said that he and his associates had no other disclosures.
On Twitter @mitchelzoler
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
MUNICH – Routinely performed hysteroscopy proved unable to increase the live-birth rate from in vitro fertilization in women who had two to four prior miscarriages after in vitro fertilization, according to results from a multicenter, controlled trial of 656 women.
Based on these findings, hysteroscopy should be limited to women with either a clinical indication or evidence of a uterine abnormality seen on transvaginal ultrasonography. Clinicians should not perform hysteroscopy in all women with a miscarriage history unless they have a reason to suspect that such an abnormality exists, said Dr. Tarek El-Toukhy in a video interview during the annual meeting of the European Society of Human Reproduction and Embryology.
Prior to this trial, some experts had hope that routine hysteroscopy could boost the live-birth rate following in vitro fertilization by 20%, 30%, or more, said Dr. El-Toukhy, a gynecologist at Guy’s and St. Thomas’ Hospital in London. But the finding that routine hysteroscopy failed to provide any benefit suggested that embryonic factors are more important than uterine factors for explaining the serial miscarriages in these women who have no clinical or ultrasound indication of a uterine problem.
Karl Storz supplied the hysteroscopy devices used in the study and training in their use. Dr. El-Toukhy said that he and his associates had no other disclosures.
On Twitter @mitchelzoler
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT ESHRE 2014
