The role of diagnostic hysteroscopy in infertility is still debated today. Despite the growing literatura demonstrating that treatment of adhesions, submucosal fibroids and uterine septa improve pregnancy rates, managing dysfunctional or inflammatory disorders remains doubtful.
Moreover, there is still a high number of reproduction units that do not perform diagnostic hysterocopy before the first IVF cycle, but who diagnose “endometrial normal” after a “normal endometrium” apparent after ultrasound study, hysterosalpingogram, saline infusion or sonohysterography. Elaborating on the issue of treatment of infertility, a recent Cochrane (Cochrane Database Review, 2013) demonstrated that the findings on the treatment of endometrial polyps are not possible given the diversity of imaging and medical decisions on which it is based. Obviously, endometrial hypertrophy is the result of hyperestrogenism and creates an unfavorable environment on which an embryo should be implanted. If the focal hypertrophy create futures polyps, why should we treat focal endometrial growths, but not widespread growths?
There is a need for randomized control trials. However, if the diagnostic techniques are not homogeneous, the results will not be. Therefore, while we diagnose polypoid endometrium, will be resected without the use of energy before an IVF cycle.