Advanced search
1 file | 486.44 KB

Hysteroscopy before in-vitro fertilisation (inSIGHT) : a multicentre, randomised controlled trial

(2016) LANCET. 387(10038). p.2622-2629
Author
Organization
Abstract
Background: Hysteroscopy is often done in infertile women starting in-vitro fertilisation (IVF) to improve their chance of having a baby. However, no data are available from randomised controlled trials to support this practice. We aimed to assess whether routine hysteroscopy before the first IVF treatment cycle increases the rate of livebirths. Methods: We did a pragmatic, multicentre, randomised controlled trial in seven university hospitals and 15 large general hospitals in the Netherlands. Women with a normal transvaginal ultrasound of the uterine cavity and no previous hysteroscopy who were scheduled for their first IVF treatment were randomly assigned (1: 1) to either hysteroscopy with treatment of detected intracavitary abnormalities before starting IVF (hysteroscopy group) or immediate start of the IVF treatment (immediate IVF group). Randomisation was done with web-based concealed allocation and was stratified by centre with variable block sizes. Participants, doctors, and outcome assessors were not masked to the assigned group. The primary outcome was ongoing pregnancy (detection of a fetal heartbeat at >12 weeks of gestation) within 18 months of randomisation and resulting in livebirth. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01242852. Findings: Between May 25, 2011, and Aug 27, 2013, we randomly assigned 750 women to receive either hysteroscopy (n=373) or immediate IVF (n=377). 209 (57%) of 369 women eligible for assessment in the hysteroscopy group and 200 (54%) of 373 in the immediate IVF group had a livebirth from a pregnancy during the trial period (relative risk 1.06, 95% CI 0.93-1.20; p=0.41). One (<1%) woman in the hysteroscopy group developed endometritis after hysteroscopy. Interpretation: Routine hysteroscopy does not improve livebirth rates in infertile women with a normal transvaginal ultrasound of the uterine cavity scheduled for a first IVF treatment. Women with a normal transvaginal ultrasound should not be offered routine hysteroscopy.
Keywords
OFFICE HYSTEROSCOPY, DIAGNOSTIC-ACCURACY, UTERINE CAVITY, TRANSVAGINAL, SONOGRAPHY, ENDOMETRIAL RECEPTIVITY, ASSISTED REPRODUCTION, PREGNANCY, RATES, IMPLANTATION, SONOHYSTEROGRAPHY, IVF

Downloads

  • (...).pdf
    • full text
    • |
    • UGent only
    • |
    • PDF
    • |
    • 486.44 KB

Citation

Please use this url to cite or link to this publication:

Chicago
Smit, Janine G, Jenneke C Kasius, Marinus JC Eijkemans, Carolien AM Koks, Ronald van Golde, Annemiek W Nap, Gabrielle J Scheffer, et al. 2016. “Hysteroscopy Before In-vitro Fertilisation (inSIGHT) : a Multicentre, Randomised Controlled Trial.” Lancet 387 (10038): 2622–2629.
APA
Smit, J. G., Kasius, J. C., Eijkemans, M. J., Koks, C. A., van Golde, R., Nap, A. W., Scheffer, G. J., et al. (2016). Hysteroscopy before in-vitro fertilisation (inSIGHT) : a multicentre, randomised controlled trial. LANCET, 387(10038), 2622–2629.
Vancouver
1.
Smit JG, Kasius JC, Eijkemans MJ, Koks CA, van Golde R, Nap AW, et al. Hysteroscopy before in-vitro fertilisation (inSIGHT) : a multicentre, randomised controlled trial. LANCET. 2016;387(10038):2622–9.
MLA
Smit, Janine G, Jenneke C Kasius, Marinus JC Eijkemans, et al. “Hysteroscopy Before In-vitro Fertilisation (inSIGHT) : a Multicentre, Randomised Controlled Trial.” LANCET 387.10038 (2016): 2622–2629. Print.
@article{8511199,
  abstract     = {Background: Hysteroscopy is often done in infertile women starting in-vitro fertilisation (IVF) to improve their chance of having a baby. However, no data are available from randomised controlled trials to support this practice. We aimed to assess whether routine hysteroscopy before the first IVF treatment cycle increases the rate of livebirths. 
Methods: We did a pragmatic, multicentre, randomised controlled trial in seven university hospitals and 15 large general hospitals in the Netherlands. Women with a normal transvaginal ultrasound of the uterine cavity and no previous hysteroscopy who were scheduled for their first IVF treatment were randomly assigned (1: 1) to either hysteroscopy with treatment of detected intracavitary abnormalities before starting IVF (hysteroscopy group) or immediate start of the IVF treatment (immediate IVF group). Randomisation was done with web-based concealed allocation and was stratified by centre with variable block sizes. Participants, doctors, and outcome assessors were not masked to the assigned group. The primary outcome was ongoing pregnancy (detection of a fetal heartbeat at {\textrangle}12 weeks of gestation) within 18 months of randomisation and resulting in livebirth. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01242852. 
Findings: Between May 25, 2011, and Aug 27, 2013, we randomly assigned 750 women to receive either hysteroscopy (n=373) or immediate IVF (n=377). 209 (57\%) of 369 women eligible for assessment in the hysteroscopy group and 200 (54\%) of 373 in the immediate IVF group had a livebirth from a pregnancy during the trial period (relative risk 1.06, 95\% CI 0.93-1.20; p=0.41). One ({\textlangle}1\%) woman in the hysteroscopy group developed endometritis after hysteroscopy. 
Interpretation: Routine hysteroscopy does not improve livebirth rates in infertile women with a normal transvaginal ultrasound of the uterine cavity scheduled for a first IVF treatment. Women with a normal transvaginal ultrasound should not be offered routine hysteroscopy.},
  author       = {Smit, Janine G and Kasius, Jenneke C and Eijkemans, Marinus JC and Koks, Carolien AM and van Golde, Ronald and Nap, Annemiek W and Scheffer, Gabrielle J and Manger, Petra AP and Hoek, Annemieke and Schoot, Benedictus C. and van Heusden, Arne M and Kuchenbecker, Walter KH and Perquin, Denise AM and Fleischer, Kathrin and Kaaijk, Eugenie M and Sluijmer, Alexander and Friederich, Jaap and Dykgraaf, Ramon HM and van Hooff, Marcel and Louwe, Leonie A and Kwee, Janet and de Koning, Corry H and Janssen, Ineke CAH and Mol, Femke and Mol, Ben WJ and Broekmans, Frank JM and Torrance, Helen L},
  issn         = {0140-6736},
  journal      = {LANCET},
  keyword      = {OFFICE HYSTEROSCOPY,DIAGNOSTIC-ACCURACY,UTERINE CAVITY,TRANSVAGINAL,SONOGRAPHY,ENDOMETRIAL RECEPTIVITY,ASSISTED REPRODUCTION,PREGNANCY,RATES,IMPLANTATION,SONOHYSTEROGRAPHY,IVF},
  language     = {eng},
  number       = {10038},
  pages        = {2622--2629},
  title        = {Hysteroscopy before in-vitro fertilisation (inSIGHT) : a multicentre, randomised controlled trial},
  url          = {http://dx.doi.org/10.1016/S0140-6736(16)00231-2},
  volume       = {387},
  year         = {2016},
}

Altmetric
View in Altmetric
Web of Science
Times cited: