Routine Hysteroscopy in IVF/ICSI Cycles in Patients With Primary Unexplained Infertility

NCT ID: NCT02416596

Last Updated: 2015-04-15

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

680 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-01-31

Study Completion Date

2017-12-31

Brief Summary

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The aim of the present study is to evaluate the impact of hysteroscopy prior to starting the IVF (in vitro fertilisation) cycle on treatment outcome in women with unexplained primary infertility.

Detailed Description

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Proper history, examination and investigations are carried out to diagnose causes of infertility. Office hysteroscopy will be performed during the Luteal phase of the proceeding menstrual cycle using a rigid hysteroscope. Controlled ovarian hyper stimulation-embryo transfer (COH-ET) using the standard long protocol of induction used in Ain Shams University Maternity Hospitals ART (assisted reproductive techniques) unit.

Biochemical pregnancy will be determined by a positive pregnancy test performed 2 weeks after embryo transfer and clinical pregnancy will be defined by the presence of a gestational sac using transvaginal ultrasound performed 6 weeks after embryo transfer.

Conditions

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Primary Infertility Unspecified Infertility Ovarian Hyperstimulation Pregnancy

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

NONE

Study Groups

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Group Undergoing Hysterosopy

This group will include 340 women with unexplained primary infertility undergoing their first trial of IVF/ICSI (intracytoplasmic sperm injection). This group will undergo hysteroscopy in the mid luteal phase of the proceeding cycle.

Group Type EXPERIMENTAL

Hysteroscopy

Intervention Type PROCEDURE

Office hysteroscopy will be performed during the Luteal phase of the proceeding menstrual cycle.

All OH (office hysteroscopy) procedures will be performed with a vaginoscopic approach without utilizing a speculum and applying traction to the cervix with a tenaculum.

Antibiotic prophylaxis: None OH will be cancelled until after treatment of vaginal infection.

Hysteroscope

Intervention Type DEVICE

The device used is a rigid hysteroscope (continuous flow, 30 degree forward oblique view) assembled in a 4-mm diameter diagnostic sheath with an atraumatic tip (Karl Storz Endoscopy).

Illumination: High intensity cold light source and fiberoptic cable Distention medium: solution of 0.9% normal saline with pressure at 100-120 mmHg

Group With No intervention

This group will include 340 women with unexplained primary infertility they will undergo their first trial of IVF/ICSI (intracytoplasmic sperm injection) without hysteroscopy in the mid Luteal phase of the proceeding cycle.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Hysteroscopy

Office hysteroscopy will be performed during the Luteal phase of the proceeding menstrual cycle.

All OH (office hysteroscopy) procedures will be performed with a vaginoscopic approach without utilizing a speculum and applying traction to the cervix with a tenaculum.

Antibiotic prophylaxis: None OH will be cancelled until after treatment of vaginal infection.

Intervention Type PROCEDURE

Hysteroscope

The device used is a rigid hysteroscope (continuous flow, 30 degree forward oblique view) assembled in a 4-mm diameter diagnostic sheath with an atraumatic tip (Karl Storz Endoscopy).

Illumination: High intensity cold light source and fiberoptic cable Distention medium: solution of 0.9% normal saline with pressure at 100-120 mmHg

Intervention Type DEVICE

Other Intervention Names

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ROH: Routine Office Hysteroscopy

Eligibility Criteria

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Inclusion Criteria

* Patients undergoing IVF/ICSI using the standard long GnRH-a (gonadotropin-releasing hormone-a) protocol.
* No evidence of uterine pathology by transvaginal ultrasound and hysterosalpingography during the follicular phase.
* Patients with unexplained primary infertility.

Exclusion Criteria

* Patients undergoing IVF using other protocols of induction.
* Patients with evidence of uterine pathology by transvaginal ultrasound or hysterosalpingography during the follicular phase.
* Other causes of infertility rather than unexplained factor.
* Unexplained poor responders during the pending ICSI cycle.
* Patients with abnormal findings at hysteroscopy.
Minimum Eligible Age

18 Years

Maximum Eligible Age

45 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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Ain Shams Maternity Hospital

OTHER

Sponsor Role lead

Responsible Party

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Amr Abdulreheem

Dr

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Khaled H Swaydan, PhD

Role: STUDY_DIRECTOR

Ain Shams University (Obs&Gyn)

Ahmed K Mekled, PhD

Role: STUDY_CHAIR

Ain Shams University (Obs&Gyn)

Central Contacts

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Amr A. Abdulreheem, MBBCh

Role: CONTACT

+201006774459

Moustafa F Gomaa, PhD

Role: CONTACT

01226188993

References

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El-Toukhy T, Sunkara SK, Coomarasamy A, Grace J, Khalaf Y. Outpatient hysteroscopy and subsequent IVF cycle outcome: a systematic review and meta-analysis. Reprod Biomed Online. 2008 May;16(5):712-9. doi: 10.1016/s1472-6483(10)60486-5.

Reference Type BACKGROUND
PMID: 18492377 (View on PubMed)

Pundir J, Pundir V, Omanwa K, Khalaf Y, El-Toukhy T. Hysteroscopy prior to the first IVF cycle: a systematic review and meta-analysis. Reprod Biomed Online. 2014 Feb;28(2):151-61. doi: 10.1016/j.rbmo.2013.09.025. Epub 2013 Oct 5.

Reference Type BACKGROUND
PMID: 24365027 (View on PubMed)

Loverro G, Nappi L, Vicino M, Carriero C, Vimercati A, Selvaggi L. Uterine cavity assessment in infertile women: comparison of transvaginal sonography and hysteroscopy. Eur J Obstet Gynecol Reprod Biol. 2001 Dec 10;100(1):67-71. doi: 10.1016/s0301-2115(01)00434-1.

Reference Type BACKGROUND
PMID: 11728660 (View on PubMed)

Karayalcin R, Ozyer S, Ozcan S, Uzunlar O, Gurlek B, Moraloglu O, Batioglu S. Office hysteroscopy improves pregnancy rates following IVF. Reprod Biomed Online. 2012 Sep;25(3):261-6. doi: 10.1016/j.rbmo.2012.05.013. Epub 2012 Jun 16.

Reference Type BACKGROUND
PMID: 22818094 (View on PubMed)

De Placido G, Clarizia R, Cadente C, Castaldo G, Romano C, Mollo A, Alviggi C, Conforti S. Compliance and diagnostic efficacy of mini-hysteroscopy versus traditional hysteroscopy in infertility investigation. Eur J Obstet Gynecol Reprod Biol. 2007 Nov;135(1):83-7. doi: 10.1016/j.ejogrb.2007.02.028. Epub 2007 May 3.

Reference Type BACKGROUND
PMID: 17481803 (View on PubMed)

Almog B, Shalom-Paz E, Dufort D, Tulandi T. Promoting implantation by local injury to the endometrium. Fertil Steril. 2010 Nov;94(6):2026-9. doi: 10.1016/j.fertnstert.2009.12.075. Epub 2010 Feb 19.

Reference Type BACKGROUND
PMID: 20171615 (View on PubMed)

Barash A, Dekel N, Fieldust S, Segal I, Schechtman E, Granot I. Local injury to the endometrium doubles the incidence of successful pregnancies in patients undergoing in vitro fertilization. Fertil Steril. 2003 Jun;79(6):1317-22. doi: 10.1016/s0015-0282(03)00345-5.

Reference Type BACKGROUND
PMID: 12798877 (View on PubMed)

Bosteels J, Weyers S, Puttemans P, Panayotidis C, Van Herendael B, Gomel V, Mol BW, Mathieu C, D'Hooghe T. The effectiveness of hysteroscopy in improving pregnancy rates in subfertile women without other gynaecological symptoms: a systematic review. Hum Reprod Update. 2010 Jan-Feb;16(1):1-11. doi: 10.1093/humupd/dmp033.

Reference Type BACKGROUND
PMID: 19744944 (View on PubMed)

Huang LN, Tan J, Hitkari J, Dahan MH. Should IVF be used as first-line treatment or as a last resort? A debate presented at the 2013 Canadian Fertility and Andrology Society meeting. Reprod Biomed Online. 2015 Feb;30(2):128-36. doi: 10.1016/j.rbmo.2014.10.004. Epub 2014 Oct 14.

Reference Type BACKGROUND
PMID: 25498596 (View on PubMed)

Hughes E, Brown J, Collins JJ, Vanderkerchove P. Clomiphene citrate for unexplained subfertility in women. Cochrane Database Syst Rev. 2010 Jan 20;2010(1):CD000057. doi: 10.1002/14651858.CD000057.pub2.

Reference Type BACKGROUND
PMID: 20091498 (View on PubMed)

Lea RG, Sandra O. Immunoendocrine aspects of endometrial function and implantation. Reproduction. 2007 Sep;134(3):389-404. doi: 10.1530/REP-07-0167.

Reference Type BACKGROUND
PMID: 17709558 (View on PubMed)

Other Identifiers

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ASMH-RH1

Identifier Type: -

Identifier Source: org_study_id

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