Impact Of Hysteroscopy On Pregnancy Outcomes In IVF-ET

1、Background:The prevalence of infertility in China increased from 11.9%in 2007 to 15.5%in2010,with 46.5%of infertile couples included in the survey seeking infertility treatment,which is lower than the global average（56%）^[3].Assisted Reproductive Technology（ART）is considered one of the most effective treatments for infertility,and the creation of In Vitro Fertilization-embryo Transfer（IVF-ET）was one of the major medical breakthroughs of the 20th century.The use of IVF-ET is increasing and it is estimated that more than 5 million children have been born worldwide with the help of this technology^[5].Despite advances in ART technology,only a quarter of IVF-ET cycles result in a successful pregnancy^[5].Facing this failure of IVF-ET treatment is stressful for doctors and patients alike.The reasons for this failure are unclear,but are usually thought to be a combination of embryo quality and intrauterine environment.In turn,one of the key players in achieving pregnancy is the intrauterine environment and hysteroscopy is the most reliable method to assess the intrauterine environment and identify intrauterine pathology,but the routine screening of hysteroscopy before IVF-ET and the timing of hysteroscopy are still controversial as reported in the national and international literature.2、Study objectives:（1）the impact of hysteroscopy on ART assisted pregnancy outcomes;（2）to explore the optimal timing of hysteroscopy during IVF-ET.3、Research Methodology:（1）Source:Retrospective study of 372 patients who underwent ART for pregnancy at Shenyang Women and Infants Hospital from January 1,2019 to December 31,2021 and met the inclusion criteria,divided into hysteroscopic group（n=208）and non-hysteroscopic group（n=164）according to whether hysteroscopy was performed before IVF-ET,age,Body Mass Index（BMI）Age,Body Mass Index（BMI）,type of infertility,years of infertility,Transvaginal Ultrasound TVS before IVF-ET and history of previous IVF-ET transplant failure were collected.（2）Statistical methods:SPSS 26.0 software was used for data analysis.The KS （Kolmogorov-Smirnov）test was performed on the measurement data-test normalityfor The measurement data that conformed to normal distribution were expressed by（x±s）,and the independent samples t-test was used for comparison between groups;the measurement data that did not conform to normal distribution were expressed by M（P25-P75）,and the Wilcoxon rank sum test was used for comparison between groups;the count data were expressed by n（%）,and the chi-square（χ2）test or Fisher’s exact test was used for comparison between groups;P<0.05 indicated that the difference was statistically The difference was statistically significant.4、RESULTS:After retrospectively collecting clinical data from the patients,the patients were continued to be followed for h CG positivity,clinical pregnancy and live birth rates,and it was found that infertile patients who underwent hysteroscopy before IVF-ET showed a higher rate of h CG positivity with a statistically significant difference（χ2=4.855,P=0.028）.In contrast,clinical pregnancy and live birth rates were higher in the hysteroscopic group than in the non-hysteroscopic group,but the difference was not statistically significant（χ2=0.119,P=0.731 vs.χ2=0.108,P=0.742）;due to the differences in age and TVS findings between the hysteroscopic and non-hysteroscopic groups,further analysis of the factors influencing the h CG-positive rate showed that between the h CG-negative and The results showed a statistically significant difference in age between the h CG negative and h CG positive groups（33.64±4.37 vs.32.53±4.35,t=2.43,P=0.016）.In addition,the rate of h CG positivity was statistically higher in patients who underwent hysteroscopy than in those who did not,with a statistically significant difference（62.13%vs.50.74%,χ2=4.855,P=0.028）;further multifactorial analysis of these factors revealed that hysteroscopy before IVF-ET was a protective factor for h CG positivity(OR=1.880.Age was an independent risk factor for h CG positivity（OR=0.925,95%CI 0.879-0.974,P=0.003）,meaning that the rate of h CG positivity decreased with age.When the TVS was not abnormal before IVF-ET,a statistically significant difference was found between the h CG positive rate,clinical pregnancy rate and live birth rate in the hysteroscopic group（n=145）compared to the non-hysteroscopic group（n=151）（51.72%vs.39.07%,χ2=4.778,P=0.029）;when patients had a normal TVS and no previous history of IVF-ET failure,those who underwent hysteroscopy showed a higher h CG positive rate.When patients had a normal TVS and no previous history of IVF-ET failure,those who underwent hysteroscopy showed a higher rate of h CG positivity and the difference was statistically significant（52.83%vs.48.68,χ2=8.064,P=0.005）;when the TVS was abnormal,the differences in h CG positivity,clinical pregnancy rate and live birth rate in the hysteroscopic group compared to the non-hysteroscopic group were found to be statistically insignificant（P>0.05）;in patients with abnormal TVS An in-depth analysis of the impact of hysteroscopy on assisted conception outcomes in patients with and without a history of IVF-ET graft failure,respectively,showed no statistical difference（P>0.05）.5、Research findings:（1）Hysteroscopy prior to IVF-ET transplantation increases the rate of positive h CG after transplantation;（2）Hysteroscopy in patients with normal TVS gives better h CG positivity when there is a history of failed IVF-ET transplantation;（3）In patients with normal TVS,hysteroscopy prior to IVF-ET transplantation may improve the clinical pregnancy and live birth rates after transplantation.