Hysteroscopy before in-vitro fertilisation (inSIGHT): a multicentre, randomised controlled trial (Apr 2016)

the lancet
Hysteroscopy before in-vitro fertilisation (inSIGHT): a multicentre, randomised controlled trial
The Lancet 27 April 2016
El-Toukhy T1, Campo R2, Khalaf Y3, Tabanelli C4, Gianaroli L4, Gordts SS5, Gordts S5, Mestdagh G2, Mardesic T6, Voboril J6, Marchino GL7, Benedetto C7, Al-Shawaf T8, Sabatini L8, Seed PT9, Gergolet M10, Grimbizis G11, Harb H12, Coomarasamy A12.
Author(s) affiliation:
1Assisted Conception Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK. Electronic address: This email address is being protected from spambots. You need JavaScript enabled to view it..
2Ziekenhuis Oost Limburg, Assisted Conception Unit, Genk, Belgium.
3Assisted Conception Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK.
4SISMER, Assisted Conception Unit, Bologna, Italy.
5Leuven Institute for Fertility and Embryology, Tiensevest, Leuven, Belgium.
6The Sanatorium Pronatal, Assisted Conception Unit, Prague, Czech Republic.
7Obstetrics and Gynaecology Department, University of Turin, Torino, Italy.
8Centre for Reproductive Medicine, Barts Health NHS Trust, London, UK.
9Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, St Thomas' Hospital, London, UK.
10Reproductive Surgery Special Interest Group, European Society of Human Reproduction and Embryology, Brussels, Belgium.
11First Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Greece.
12Institute of Metabolism and Systems Research and Tommy's National Centre for Miscarriage Care and Research, University of Birmingham, Birmingham, UK.


Short description:
Hysteroscopy is often done in infertile women starting in-vitro fertilisation (IVF) to improve their chance of having a baby. However, no data are available from randomised controlled trials to support this practice. We aimed to assess whether routine hysteroscopy before the first IVF treatment cycle increases the rate of livebirths.
Link to the journal


Abstract taken from PubMed

The success rate of in-vitro fertilisation (IVF) remains low and many women undergo multiple treatment cycles. A previous meta-analysis suggested hysteroscopy could improve outcomes in women who have had recurrent implantation failure; however, studies were of poor quality and a definitive randomised trial was needed. In the TROPHY trial we aimed to assess whether hysteroscopy improves the livebirth rate following IVF treatment in women with recurrent failure of implantation.
We did a multicentre, randomised controlled trial in eight hospitals in the UK, Belgium, Italy, and the Czech Republic. We recruited women younger than 38 years who had normal ultrasound of the uterine cavity and history of two to four unsuccessful IVF cycles. We used an independent web-based trial management system to randomly assign (1:1) women to receive outpatient hysteroscopy (hysteroscopy group) or no hysteroscopy (control group) in the month before starting a treatment cycle of IVF (with or without intracytoplasmic sperm injection). A computer-based algorithm minimised for key prognostic variables: age, body-mass index, basal follicle-stimulating hormone concentration, and the number of previous failed IVF cycles. The order of group assignment was masked to the researchers at the time of recruitment and randomisation. Embryologists involved in the embryo transfer were masked to group allocation, but physicians doing the procedure knew of group assignment and had hysteroscopy findings accessible. Participants were not masked to their group assignment. The primary outcome was the livebirth rate (proportion of women who had a live baby beyond 24 weeks of gestation) in the intention-to-treat population. The trial was registered with the ISRCTN Registry, ISRCTN35859078.
Between Jan 1, 2010, and Dec 31, 2013, we randomly assigned 350 women to the hysteroscopy group and 352 women to the control group. 102 (29%) of women in the hysteroscopy group had a livebirth after IVF compared with 102 (29%) women in the control group (risk ratio 1·0, 95% CI 0·79-1·25; p=0·96). No hysteroscopy-related adverse events were reported.
Outpatient hysteroscopy before IVF in women with a normal ultrasound of the uterine cavity and a history of unsuccessful IVF treatment cycles does not improve the livebirth rate. Further research into the effectiveness of surgical correction of specific uterine cavity abnormalities before IVF is warranted.
European Society of Human Reproduction and Embryology, European Society for Gynaecological Endoscopy.
Link to the paper on PubMed
Comment in:
Hysteroscopy before IVF: can it improve outcomes? [Lancet. 2016]


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