Approximately 15 percent of couples are affected with subfertility, of which up to 20
percent remain unexplained. Uterine cavity abnormalities can be a contributing cause of
subfertility and recurrent implantation failure. Uterine cavity assessment has been
suggested as a routine investigation in the evaluation of subfertile women.
Traditionally, hysterosalpingography has been the most commonly used technique in
the evaluation of infertility. Transvaginal ultrasound scan allows visualization of the
endometrial lining and cavity and has been used as a screening test for the assessment
of uterine cavity.
Abnormal uterine findings on a baseline scan can be further evaluated with saline
hysterosonography, which is highly sensitive and specific in identifying intrauterine
abnormalities.
Hysteroscopy is considered as the definitive diagnostic tool to evaluate any abnormality
suspected on hysterosalpingography, transvaginal ultrasound scan, or saline
hysterosonography during routine investigation of infertile patients. Minimally invasive
hysteroscopes have minimized the pain experienced by patients during the procedure
and made it feasible to use hysteroscopy as a routine outpatient examination.
Following recurrent IVF failure, there is some evidence of benefit from hysteroscopy in
increasing the chance of pregnancy in the subsequent IVF cycle, both in those with
abnormal and normal hysteroscopic findings. Various possible mechanisms have been
proposed for this beneficial effect, but more randomized controlled trials are needed
before its routine use in the general subfertile population can be recommended.