Impaired fertility represents a clinical challenge. Failures of in vitro fertilization (IVF) cycles could be due to multiple factors including embryonic, uterine, and technical related issues. Unfortunately, in most circumstances, the cause of failure remains unknown. However, it is recognized that intrauterine pathologies are the cause of IVF failure in about 10-15% of patients. Up to 50% of women with recurrent implantation failure are diagnosed with intrauterine pathologies. Therefore, before proceeding with assisted reproduction techniques (ART), the clinician should rigorously evaluate the uterine cavity allowing the early diagnosis and effective treatment of potential factors that could reduce the success of the ART attempt. To achieve this goal, In-office diagnostic hysteroscopy represents the gold-standard technique for the evaluation and management of intrauterine pathologies that could potentially interact with embryo implantation, reducing the chances of achieving a clinical pregnancy. As a matter of fact, intrauterine pathologies are more often discovered in sub-fertile and infertile women.

Advances in ultrasound technology enabled the physicians to delineate most uterine pathologies without the need to resort to more invasive diagnostic procedures. When in doubt and when high resolution transvaginal ultrasound is not optimal due to patient related factors such as obesity, endometriosis and uterine fibroids, hysteroscopy plays a major role in confirming the normality of the uterine cavity. Hysteroscopy remains to be the gold standard in evaluation and treatment of intrauterine pathologies and when combined with endometrial biopsy has the ability to show subtle causes of implantation failure such as chronic endometritis. Endometrial biopsy is essential in diagnosing chronic endometritis: An endometrial biopsy positive for plasma cells and CD138 is highly predictive for chronic endometritis, which is common in cases of repeated and unexplained implantation failure following ART. However, it is important to note that hysteroscopy should be avoided when in presence of suspected or confirmed acute pelvic infection..

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Mishita
Jornal co-ordinator
Journal of General Surgery Reports