The position of hysteroscopy in current fertility practice is under debate. There are many randomized controlled trials on technical feasibility and patient compliance demonstrating that the procedure is well tolerated and effective in the treatment of intrauterine pathologies. However, no consensus on the effectiveness of hysteroscopic surgery in improving the prognosis of subfertile women is available. A literature review was performed to explore the available information regarding the role of hysteroscopy in the evaluation and management of female infertility as well as to ascertain evidence that treatment of these uterine abnormalities improves fertility. The debate regarding the role of hysteroscopic surgery in the management of female infertility remains as the published studies did not reach a consensus on the benefit of such an intervention in this setting. The randomized trials do not clearly demonstrate that surgical correction of all intrauterine abnormalities improves IVF outcome. However, published observational studies suggest a benefit for resection of submucosal leiomyomas, adhesions, and endometrial polyps in increasing pregnancy rates. More randomised controlled studies are needed to substantiate the effectiveness of the hysteroscopic removal of suspected intrauterine pathology in women with unexplained subfertility or prior to assisted reproductive technology. 1. Introduction The introduction of hysteroscopy in gynecologic practice revolutionized the diagnosis and treatment of intrauterine disease. New methodological and technological developments have made diagnostic and operative hysteroscopy much more efficient, cost effective, safe, and useful. The most common indication for hysteroscopy is abnormal uterine bleeding (AUB), but it is also used in cases of infertility and Mullerian anomalies [1, 2]. Uterine factors can be found in only 2 to 3% of infertile women, but intrauterine lesions are much more common in this setting (40–50%) [3, 4]. These lesions can compromise spontaneous fertility as well as reduce pregnancy rates in assisted reproduction [3, 4]. Published observational studies suggest increased pregnancy rates after the hysteroscopic removal of endometrial polyps, submucous fibroids, uterine septum, or intrauterine adhesions, which can be found in 10% to 15% of women seeking treatment for subfertility [3]. Evaluation of the uterine cavity is a basic step in female infertility workup. Classically, hysterosalpingography and transvaginal sonography are most commonly used for this purpose. Hysteroscopy, however, is considered
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