Outcomes and complications of pre-assisted reproductive technology hysteroscopic evaluation and treatment: a cross-sectional study at a Nigerian teaching hospital.

Abstract

Background: Hysteroscopy plays a vital role in diagnosing and managing intrauterine pathologies that could impair reproductive success. It is especially valuable for women seeking assisted reproductive technology (ART), as structural uterine abnormalities-such as adhesions, polyps, and fibroids-can reduce implantation success or increase the risk of miscarriage. This pre-ART evaluation method is crucial in low-resource settings like Nigeria, where optimizing every ART cycle is essential due to high costs and limited access. This study assesses the hysteroscopic findings, procedural outcomes, and reproductive results among women undergoing pre-ART hysteroscopy at a tertiary hospital in Lagos, Nigeria.

Methods: This retrospective cross-sectional study reviewed the medical records of 121 women who underwent diagnostic or operative hysteroscopy between August 2019 and October 2023 at the Lagos State University Teaching Hospital (LASUTH). Among these women, 91 (75.2%) received hysteroscopy as part of pre-ART assessment. Data collected included demographics, hysteroscopic diagnoses, procedural types, complications, and post-hysteroscopy ART outcomes. Analyses were conducted using SPSS version 27.0, with results presented in terms of frequencies, percentages, means, and standard deviations.

Results: The mean age of participants was 37.7 years, with most (78%) aged 35 years or older. A significant majority had no previous live births (91.6%) or prior ART experience (86.8%). Hysteroscopic findings included intrauterine adhesions (45%), endometrial polyps (22%), and normal endometrial cavities (22%). Operative hysteroscopy was conducted in 78% of cases, with intrauterine adhesiolysis (50.5%) and polypectomy (22%) as the most frequent procedures. Complications were rare, with only 8.8% of therapeutic procedures resulting in issues, primarily uterine perforation. Of the 73 women who continued with ART post-hysteroscopy, 28.1% achieved pregnancy following IVF and embryo transfer.

Conclusion: Pre-ART hysteroscopy is beneficial in identifying and managing intrauterine pathologies that could hinder ART success. In this study, intrauterine adhesions were the most common finding, and therapeutic interventions were effectively performed with minimal complications. These findings support the use of hysteroscopy as an integral component of ART preparation, particularly in resource-constrained settings, to improve reproductive outcomes and optimize ART cycles.