The effectiveness of hysteroscopy in improving pregnancy rates in subfertile women without other gynaecological symptoms: A systematic review

Jan Bosteels, Steven Weyers, Patrick Puttemans, Costas Panayotidis, Bruno Van Herendael, Victor Gomel, Ben W.J. Mol, Chantal Mathieu, Thomas D'Hooghe

Research output: Contribution to journalReview articlepeer-review

176 Citations (Scopus)


Background: Although hysteroscopy is frequently used in the management of subfertile women, a systematic review of the evidence on this subject is lacking. Methods: We summarized and appraised the evidence for the benefit yielded by this procedure. Our systematic search was limited to randomized and controlled studies. The QUOROM and MOOSE guidelines were followed. Language restrictions were not applied. Results: We identified 30 relevant publications. Hysteroscopic removal of endometrial polyps with a mean diameter of 16 mm detected by ultrasound doubles the pregnancy rate when compared with diagnostic hysteroscopy and polyp biopsy in patients undergoing intrauterine insemination, starting 3 months after the surgical intervention [relative risk (RR) = 2.3; 95% confidence interval (CI): 1.6-3.2]. In patients with one fibroid structure smaller than 4 cm, there was a marginally significant benefit from myomectomy when compared with expectant management (RR = 1.9; 95% CI: 1.0-3.7). Hysteroscopic metroplasty for septate uterus resulted in fewer pregnancies in patients with subfertility when compared with those with recurrent pregnancy loss (RR = 0.7; 95% CI: 0.5-0.9). Randomized controlled studies on hysteroscopic treatment of intrauterine adhesions are lacking. Hysteroscopy in the cycle preceding a subsequent IVF attempt nearly doubles the pregnancy rate in patients with at least two failed IVF attempts compared with starting IVF immediately (RR = 1.7; 95% CI: 1.5-2.0). Conclusions: Scarce evidence on the effectiveness of hysteroscopic surgery in subfertile women with polyps, fibroids, septate uterus or intrauterine adhesions indicates a potential benefit. More randomized controlled trials are needed before widespread use of hysteroscopic surgery in the general subfertile population can be justified.

Original languageEnglish
Article numberdmp033
Pages (from-to)1-11
Number of pages11
JournalHuman Reproduction Update
Issue number1
Publication statusPublished or Issued - 10 Sept 2009
Externally publishedYes


  • Hysteroscopy
  • IVF
  • Intrauterine insemination
  • RCT
  • Subfertility

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynaecology

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