The most recent evidences suggest that hysteroscopy in asymptomatic women prior to their first IVF cycle could be associated with improved treatment outcome when performed just before commencing the IVF cycle, but this conclusion is based in a meta-analysis, and some controversy still persists due to the lack of a robust, well-designed, randomized trial [Pundir et al. 2014]
The inSIGHT study is a large multicenter randomised controlled trial coordinated by the Utrecht University Medical Center with data from 25 centers in the Netherlands. This study is being conducted in asymptomatic subfertile women, with indication for a first IVF/ICSI treatment cycle, and normal findings at transvaginal sonography. In this trial, the effects on pregnancy rates and costs of SIS and hysteroscopy will be studied. The results of this study, which are expected in 2015, will help to clarify the significance of hysteroscopy prior to IVF/ICSI treatment [Smit JG et al 2012].
Until we have better evidence, the controversy is served. Benefits of hysterocospy prior to the IVF cycle seems to be clear, and evidence exists that performing hysteroscopy before IVF treatment significantly increases the chance of pregnancy in the subsequent IVF cycle in women who had one or more failed IVF cycles [Bosteels et al 2010, Demirol et al 2004, El- Toukhy et al 2008]. However things are not so clear in the evaluation prior to the first IVF cycle, and there is no agreement about recommending the inclusion of hysteroscopy as a routine procedure prior to the first IVF cycle.