Hysteroscopy in an IVF-ER program. Clinical experience with 360 infertile patients.

Three hundred and sixty patients underwent hysteroscopy before entering the IVF program. The procedure was successful in 332 patients; obstructive tubal disease was present in 247 (70%); 148 showed uterine abnormalities (44.5%) such as endometrial polyps, adhesions, hypoplasia, malformations, or severe cervical stenosis; 114 patients had normal hysterographic findings, in whom hysteroscopy revealed a false-negative rate of 36.8%. In 281 patients (84.6%) hysteroscopy was carried out under general anesthesia, in most cases associated with laparoscopy. There were no anesthetic complications, uterine perforations or other significant problems. In an IVF program, hysteroscopic evaluation can reduce the failure rate due to intra-uterine abnormalities. Hysteroscopy, which permits one to optimize an IVF attempt, becomes an essential procedure before introducing a patient into an IVF program.