Optimal Interval of Time from Operative Hysteroscopy to Embryo Transfer in an In Vitro Fertilization Cycle

J Minim Invasive Gynecol. 2019 Sep-Oct;26(6):1083-1087.e1. doi: 10.1016/j.jmig.2018.10.019. Epub 2018 Oct 30.


Study objective: Data are limited regarding optimal timing between operative hysteroscopy and embryo transfer (ET). This study aimed to assess whether the time interval from operative hysteroscopy to ET affects implantation and clinical pregnancy rates.

Design: Retrospective cohort study (Canadian Task Force classification II-2).

Setting: Private academic center.

Patients: All patients who had operative hysteroscopy followed by a day 5 ET from 2012 to 2017.

Intervention: Interval of time from operative hysteroscopy to ET.

Measurements and main results: The interval of time from hysteroscopy to ET was calculated, and linear regression analyses were performed to assess the impact on clinical outcome. A subanalysis of patients who underwent subsequent single, euploid, frozen ET(s) was performed. A total of 318 patients were included. Indications for hysteroscopy included polypectomy (n = 205), myomectomy (n = 36), lysis of adhesions (n = 46), septum resection (n = 19), and retained products of conception (n = 12). The mean interval of time from hysteroscopy to ET was 138.4 ± 162.7 days (range, 20-1390). There was no significant difference in mean interval of time between procedure and subsequent ET when comparing patients who achieved and did not achieve implantation. Patients stratified by interval of time from operative hysteroscopy to ET had similar clinical outcomes. The time interval from hysteroscopy had no impact on odds of implantation (odds ratio [OR], 1.001; 95% confidence interval [CI], .999-1.002; p = .49), ongoing pregnancy (OR, 1.001; 95% CI, .999-1.002; p = .42), or early pregnancy loss (OR, .997; 95% CI, .994-1.000; p = .07) (adjusted for oocyte age, recipient age, endometrial thickness, use of preimplantation genetic testing, use of donor egg, fresh vs frozen ET, ET count). Similar results were observed in the subanalysis restricted to euploid single frozen ETs from autologous cycles.

Conclusion: The time interval from operative hysteroscopy to subsequent ET does not impact the likelihood of successful clinical outcome. Patients who have undergone operative hysteroscopy do not need to delay fertility treatment.

Keywords: Assisted reproductive technologies; Endometrium; Implantation; Live birth; Pregnancy; Wound healing.

MeSH terms

  • Abortion, Spontaneous / epidemiology
  • Abortion, Spontaneous / etiology
  • Adult
  • Cohort Studies
  • Embryo Implantation / physiology*
  • Embryo Transfer* / methods
  • Embryo Transfer* / statistics & numerical data
  • Female
  • Fertilization in Vitro* / methods
  • Fertilization in Vitro* / statistics & numerical data
  • Humans
  • Hysteroscopy / adverse effects
  • Hysteroscopy / rehabilitation*
  • Hysteroscopy / statistics & numerical data
  • Pregnancy
  • Pregnancy Outcome / epidemiology
  • Pregnancy Rate
  • Retrospective Studies
  • Time Factors
  • Time-to-Pregnancy*
  • Wound Healing / physiology