İn Vitro Fertilizasyonda İlk Siklus Öncesi Tanısal Histeroskopinin Gebelik Sonuçları Üzerine Etkisi
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ABSTRACT Tanacan A. , The Effect of Diagnostic Hysteroscopy Before The First in Vitro Fertilisation Cycle on Pregnancy Outcome Measures, Hacettepe University Faculty of Medicine, Thesis in Obstetrics and Gynecology, Ankara, 2015. Hysteroscopy is a gynecologic procedure which is done to visualise the endometrial cavity and it provides some surgical interventions in this area. Assisted reproductive technology (ART) procedures are used successfully in infertility treatment especially in ovulation problems, tubal-servical pathologies and in male factor infertility. Endometrial receptivity is a process in which cytokines, growth factors and adhesion molecules take place . This process is affected by endometrial pathologies like submucosal myomas, endometrial polyps and uterin septums so the uterin cavity must be evaluated before the intervention to enhance the treatment outcome. With recent studies the opinion of applying hysteroscopy before IVF cycle may enhance the implantation rate, clinic pregnancy rate and live birth rate is debated. The aim of this study is to find out the effect of diagnostic hysteroscopy before the first IVF cycle on pregnancy outcome measures. This is a retrospective study which includes the data of 673 patients who underwent their first IVF cycle and without any shown endometrial pathology by transvaginal ultrasonography and/or histerosalpingography between 01. 01.2010 and 01. 11. 2014. Hysteroscopy was applied to 122 patients before IVF cycle and 551 patients were treated without hysteroscopy. The results of implantation rate, clinic pregnancy rate and livebirth rate for hysteroscopy and control group were 22,2% versus 21,5% (p=0,8), 31,1% versus 32,8% (p=0,7) and 23,8% versus %16,7 (p=0,06) respectively. Female age, Body Mass Index (BMI), duration of infertility, Antral folicul count (AFC) , time interval between embryo transfer and hysteroscopy, induction duration with gonadotropins, total gonadotropin dosage, blood ostradiol value on the day of hCG administration, total oocyte number, metaphase-2 oocyte number, total day 3 and 5 embryo numbers, total number of embryos transfered, ˃ 7 cell < 10 % fragmented embryo number, easy embryo transfer ratio and the ratio of cervical bleeding during the embryo transfer were also assessed as they may influence the pregnancy outcome measures. There was no statistically significant differance between the groups for these values. In addition a logistic regression analysis was used for the effect of female age, BMI, infertility duration, total oocyte number and the time interval between hysteroscopy and embryo transfer. Again no statistically significant effect was found. With regard to these findings we can say that; there is no beneficial effect of hysteroscopy on pregnancy outcome measures in patient undergoing their first IVF cycle without known endometrial pathology but for more certain judgement multy populated prospective randomised controlled trials are needed.