Guideline No. 446: Hysteroscopic Surgery in Fertility Therapy

J Obstet Gynaecol Can. 2024 Feb;46(2):102400. doi: 10.1016/j.jogc.2024.102400. Epub 2024 Feb 5.

Abstract

Objective: To evaluate the indications, benefits, and risks of hysteroscopy in the management of patients with infertility and provide guidance to gynaecologists who manage common conditions in these patients.

Target population: Patients with infertility (inability to conceive after 12 months of unprotected intercourse) undergoing investigation and treatment.

Benefits, harms, and costs: Hysteroscopic surgery can be used to diagnose the etiology of infertility and improve fertility treatment outcomes. All surgery has risks and associated complications. Hysteroscopic surgery may not always improve fertility outcomes. All procedures have costs, which are borne either by the patient or their health insurance provider.

Evidence: We searched English-language articles from January 2010 to May 2021 in PubMed/MEDLINE, Embase, Science Direct, Scopus, and Cochrane Library (see Appendix B for MeSH search terms).

Validation methods: The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional recommendations).

Intended audience: Gynaecologists who manage common conditions in patients with infertility.

Tweetable abstract: When offering hysteroscopic surgery to patients with infertility, ensure it improves the live birth rate.

Summary statements: RECOMMENDATIONS.

Keywords: hysteroscopy; infertility; leiomyoma; tissue adhesions; uterine diseases.

Publication types

  • Practice Guideline

MeSH terms

  • Female
  • Fertility
  • Health Services
  • Humans
  • Hysteroscopy* / adverse effects
  • Infertility* / therapy
  • Pregnancy
  • Treatment Outcome