Prevalência de alterações histeroscópicas em mulheres submetidas à fertilização in vitro: estudo retrospectivo

Abstract

Recent clinical trials showed no benefit of performing routine hysteroscopy before in vitro fertilization (IVF) in women with normal intrauterine imaging. However, these trials found hysteroscopic abnormalities in less than 13% of the participants and, therefore, their findings might not be applicable to populations with higher prevalence of intrauterine disorders. We carried out a retrospective cross-sectional study of 1141 consecutive women who underwent outpatient hysteroscopy before IVF at a tertiary academic center. Of these, 961 participants had a normal transvaginal sonography (TVS) of the uterine cavity. Hysteroscopic alterations were present in 265/961 of patients with a negative TVS (prevalence 27.6%, 95% confidence interval [CI] 24.8%-30.5%). The prevalence of unsuspected submucous leiomyoma increased significantly with age (p=0.005, chi-square test for linear trend) and reached 7.2% (95% CI 3.5%-14.1%) after 40 years. The sensitivity of TVS ranged from 8% (95% CI 2%-20%) for uterine synechiae to 41% (95% CI 28%-56%) for submucous leiomyoma, resulting in low likelihood ratios for negative TVS results. These findings suggest a high prevalence of unsuspected alterations found by routine hysteroscopy before IVF, an age dependent increase in the frequency of submucous leiomyoma and a low diagnostic sensitivity of TVS to detect intracavitary lesions.