The relationship of pre-IVF/ICSI/ET hysteroscopic endometrial injury and hysteroscopic polypectomy with reproductive results in the management of infertil patients

Introduction and Aim Hysteroscopy is a commonly used minimally invasive technique in infertility management. The achievement of optimal endometrial preparation for embryo transfer is recognized as a crucial factor in enhancing the success of in vitro fertilization (IVF). Consequently, a thorough hysteroscopic examination of the uterus and endometrium and to perform appropriate operative procedures, become significant to ensure favourable outcomes. This thesis aims to evaluate the impact of hysteroscopic polypectomy and hysteroscopic injury on reproductive outcomes. Material and methods The statistical analysis involved 391 patients who underwent IVF/ICSI/ET treatment at the Assisted Conception Unit of The Maltepe University Obstetrics and Gynecology Department. They were categorized into three groups: hysteroscopic injury (Group A) (n=105), hysteroscopic polypectomy (Group B) and control group (Group C) (n=181). Results The study examined parameters including biochemical pregnancy rate, clinical pregnancy rate, live birth rate and abortion rate. In Group A, the rates of biochemical pregnancy, clinical pregnancy, live birth and abortion were 49.5%, 41.9%, 27.6% and 14.3%, respectively. Group B had rates of 44.8%, 41%, 31.4% and 8.6% for the same parameters, while Group C had rates of 39.2%, 33.7%, 23.8% and 8.8%, respectively. Statistical analysis revealed no significant differences between the groups in terms of biochemical pregnancy, clinical pregnancy, live birth, and abortion rates (p: 0.227, 0.288, 0.362 and 0.276 respectively). xii Conclusions The study demonstrated a positive impact of hysteroscopic endometrial injury on reproductive outcomes, although the observed effects did not reach statistical significance. Evaluating the results is challenging due to variations in the techniques used by clinicians in previous literature studies. It is essential to conduct comprehensive research specific to different age and patient groups to define the hysteroscopic injury technique accurately. Although the increase in the number of pregnancies in the hysteroscopic polypectomy group was not statistically significant, the excision of endometrial polyps successfully reduced the abortion rate to levels similar to the group without intrauterine pathology. Considering the potential of endometrial polyps to cause pregnancy loss, the hysteroscopic removal of polyps improves reproductive outcomes.