The diagnosis and treatment outcome of hysteroscopy in infertility

Objective To explore the incidence of uterine cavity disease and the analysis of pregnancy outcome after hysteroscopic treatment. Methods Total 8 546 infertile patients who accepted hysteroscopy were analyzed retrospectively from January 2015 to August 2016. According to patients’ age, they were divided into two groups: <35-year-old group (6 786 cases), ≥35-year-old group (1 760 cases), and the incidence of intrauterine lesions were compared between the two groups. Among the patients whose embryos were transferred sucessfully, they were divided into two subgroups according to hysteroscopy results: normal subgroup and treatment subgroup. Among the <35 years old group, 2 192 cases were included in the normal subgroup, and 531 cases were in treatlment subgroup. Of≥35-year-old group 613 cases were included in the normal subgroup and 162 cases were in treatment subgroup. The pregnancy outcomes were compared between the two subgroups. Results The incidence of intrauterine lesions in advanced women ≥35-year-old (19.66%) was significantly higher than women <35-year-old (16.92%, P=0.007). The highest proportion of intrauterine lesions was endometrial polyps in both groups, with the incidence rates of 11.36% and 7.97% respectively, followed by simple uterine hyperplasia, intrauterine adhesions and uterine malformations. The incidence of endometrial tuberculosis was rare. Among the infertile women who underwent hysteroscopy treatmen for intrauterine lesions, the clinical pregnancy rate (66.5%) was not significantly different from that in uterine cavity non-lesioned patients (65.1%) in women <35-year-old (P=0.865). However, the clinical pregnancy rate (24.7%) and implantation rate (16.5%) in the≥35-year-old female treatment subgroup were significantly lower than those in the normal subgroup without uterine lesions (36.2%, P=0.006; 23.6%, P=0.008). Conclusion The incidence of uterine cavity disease is 16%~20%. Hysteroscopic treatment of uterine cavity lesions can significantly improve the pregnancy outcomes of infertile patients less than 35 years of age, but for the elderly infertility patients, the pregnancy outcomes after treatment was still inferior to the normal patients of the same age. Key words: Hysteroscopy; Intrauterine lesions; Pregnancy outcome