Hysteroscopic evaluation of endometrial cavity in cases of unexplained infertility patients less than 35 years old


  • Nagwan Ahmed Bahgat Department of Obstetrics and Gynaecology, Mansoura Faculty of Medicine, Mansoura, Egypt; Health Plus Fertility Center, Health plus group, Abu Dhabi, UAE




Hysteroscopy, Endometrium, Infertility


Background: The incidence of un explained infertility about 22-28% of all infertile couples. Several strategies have been implemented to improve the outcome of infertility treatment before shifting to ART. Management of unexplained infertility depends on patients age, ovarian reserve and period of infertility, management starts from simple to more complicated protocols to achieve pregnancy up to assisted reproduction techniques. Hysteroscopy provides diagnostic and therapeutic approach in such group of patients.

Methods: Retrospective analysis of the reproductive outcome in young patients with unexplained infertility was conducted to evaluate such treatment protocol 163 patients included in the study.

Results: Our results showed that around 29.4% of patients had intrauterine abnormalities which varies from endometrial polys to adhesions and one case found to have cervical stenosis, around 12.17% had endometritis. Patient were left for expectant management for 6 months, 22.7% pregnancy rate following hysteroscopy without any other intervention, patients who had polypectomy got 28% pregnancy rate while patients with apparent normal endometrial cavity got 23.76% pregnancy rate.

Conclusions: Hysteroscopy could be an alternative treatment option in young patients with unexplained infertility because of its diagnostic and therapeutic effect.  


Isaksson R, Tiitinen A. Present concept of unexplained infertility. Gynecol Endocrinol. 2004;18(5):278-90.

Kamath MA, Bhattacharya S. Demographics of infertility and management of unexplained infertility. Best Pract Res Clin Obstet Gynaecol. 2012;26(6):729-38.

Ray A, Shah A, Gudi A, Homburg R. Unexplained infertility: an update and review of practice. Reprod Biomed Online. 2012;24(6):591-602.

Liu K, Case A. Reproductive endocrinology and infertility committee, Advanced reproductive age and fertility. J Obstet Gynaecol Can. 2011;33(11):1165-75.

Bhattacharya S, Harrild K, Mollison J, Wordsworth S, Tay C, Harrold A et al. Clomifene citrate or unstimulated intrauterine insemination compared with expectant management for unexplained infertility: pragmatic randomised controlled trial. BMJ. 2008;337:a716.

Pandian Z, Bhattacharya S, Nikolaou D, Vale L, Templeton A. The effectiveness of IVF in unexplained infertility: a systematic Cochrane review. Hum Reprod. 2003;18(10):2001-7.

Fatum M, Laufer N, Simon A. Investigation of the infertile couple: should diagnostic laparoscopy be performed after normal hysterosalpingography in treating infertility suspected to be of unknown origin? Human-Reproduction. 2002;17(1):1-3.

Ayida G, Chamberlain P, Barlow D, Koninckx P, Golding S, Kennedy S. Is routine diagnostic laparoscopy for infertility still justified? A pilot study assessing the use of hysterosalpingo-contrast sonography and magnetic resonance imaging. Hum Reprod. 1997;12(7):1436-9.

Preutthipan S, Linasmita V. A prospective comparative study between hysterosalpingography and hysteroscopy in the detection of intrauterine pathology in patients with infertility. J Obstet Gynaecol Res. 2003;29(1):33-7.

Abid HB, Fekih M, Fathallah K, Chachia S, Bibi M, Khairi H. Office hysteroscopy before first in vitro fertilization. A randomized controlled trial. J Gynecol Obstet Hum Reprod. 2021;50(7):102109.

Benkaddour YA, Gervaise A, Fernandez H. Which is the method of choice for evaluating uterine cavity in infertility workup? J Gynecol Obstet Biol Reprod (Paris). 2010;39(8):606-13.

Niknejadi M, Haghighi H, Ahmadi F, Niknejad F, Chehrazi M, Vosough A et al. Diagnostic accuracy of transvaginal sonography in the detection of uterine abnormalities in infertile women. Iran J Radiol. 2012;9(3):139-44.

La Sala GB, Blasi I, Gallinelli A, Debbi C, Lopopolo G, Vinci V et al. Diagnostic accuracy of sonohysterography and transvaginal sonography as compared with hysteroscopy and endometrial biopsy: a prospective study. Minerva Ginecol. 2011;63(5):421-7.

Ayida G, Chamberlain P, Barlow D, Kennedy S. Uterine cavity assessment prior to in vitro fertilization: comparison of transvaginal scanning, saline contrast hystero-sonography and hysteroscopy. Ultrasound Obstet Gynecol. 1997;10(1):59-62.

Bozdag G, Aksan G, Esinler I, Yarali H. What is the role of office hysteroscopy in women with failed IVF cycles? Reprod Biomed Online. 2008;17(3):410-5.

Makled AK, Farghali MM, Shenouda DS. Role of hysteroscopy and endometrial biopsy in women with unexplained infertility. Arch Gynecol Obstet. 2014;289(1):187-92.

Wadhwa L, Mishra M. Therapeutic Efficacy of Endometrial Scratching in Repeated Controlled Ovarian Stimulation (COS) Failure Cycles. J Hum Reprod Sci. 2018;11(1): 59-71.

Seyam EM, Hassan MM, Sayed Gad MTM, Mahmoud HS, Mostafa Gamal Ibrahim, Pregnancy Outcome after Office Microhysteroscopy in Women with Unexplained Infertility. Int J Fertil Steril. 2015;9(2):168-75.

Johnson N, Vandekerckhove P, Watson A, Lilford R, Harada T, Hughes E. Tubal flushing for subfertility. Cochrane Database Syst Rev. 2005;18;(2):CD003718.

Chunyan G, Bin P, Ping Y, Yue Z, Yang X, Hongju T et al. Assessment of the Influence on Spontaneous Pregnancy of Hysterosalpingo-Contrast Sonography. Biomed Res Int. 2018;2018:4901281.






Original Research Articles