Efficacy of hysteroscopy in improving reproductive outcomes of infertile couples: a systematic review and meta-analysis

摘要: BACKGROUND The scientific community has been re-evaluating the clinical relevance of hysteroscopy in diagnosis and treatment uterine factors its role infertility work-up, thanks to potential capability improve reproductive outcomes reduce time pregnancy. OBJECTIVE AND RATIONALE The objective this systematic review meta-analysis was assess efficacy diagnostic operative improving live birth rate (LBR) infertile women, with without intrauterine abnormalities, at any stage work-up. SEARCH METHODS PubMed, Embase, Cochrane Library Clinical Trials Registry using Medical Subject Headings free text terms were searched up June 2014, language or year restrictions. Randomized controlled trials (RCTs) enrolling women no suspected cavity abnormalities comparing versus but prior first attempt standard IVF ICSI after (one more) failed attempts IVF/ICSI included. RCTs also Risk bias assessed criteria recommended by Collaboration overall quality evidence GRADE approach. Results pooled random effect model. OUTCOMES The primary outcome evaluated LBR, while secondary pregnancy rate, miscarriage procedure-related complications. Five hundred eighty-eight records retrieved removing duplicates. Nine studies included, 2976 participants. Four included one more cycles. Two who candidates for their IVF/ICSI. One study both affected fibroids endometrial polyps, had not received nor candidates. Seven meta-analysis. Comparing (first subsequent) there very low-quality that increased LBR (relative risk (RR) 1.48, 95% confidence interval (CI) 1.20-1.81; three 1088 participants) moderate it (RR 1.45, CI 1.26-1.67; seven studies, 2545 participants). on confirmed subgroup analysis five including only implantation failures 1.41, 1.14-1.75) where performed before 1.55, 1.26-1.91). already diagnosed polyps fibroids, increases 2.13, 1.56-2.92). None LBR. WIDER IMPLICATIONS Robust high-quality are still needed can be regarded as a first-line procedure all especially during basal assessment couple, when assisted is indicated yet.