Patient and provider satisfaction with saline ultrasound versus office hysteroscopy for uterine cavity evaluation prior to in vitro fertilization: a randomized controlled trial

Abstract

Purpose: To compare patient and provider satisfaction with saline ultrasound (SIS) versus office hysteroscopy for cavity evaluation prior to in vitro fertilization (IVF) and to assess the capability of hysteroscopy to manage pathology at time of diagnosis to reduce delays and supernumerary procedures.

Methods: This was a randomized, controlled trial in a university fertility clinic. One hundred enrolled subjects undergoing routine uterine cavity evaluation prior to planned embryo transfer were randomized to SIS or office hysteroscopy without anesthesia. Subjects and providers completed surveys about their experience. Subjects with findings on SIS had a hysteroscopy performed or scheduled for further evaluation. Those with hysteroscopy findings had management attempted within the same procedure.

Results: Overall patient satisfaction was high and did not differ between groups, while providers indicated that hysteroscopy provided a better cavity evaluation. There was no difference in time to complete procedures between groups. Pain score on a ten-scale was slightly higher in the hysteroscopy group compared to the SIS group (3.38 ± 1.85 vs. 2.44 ± 1.64, p < 0.01), but this did not impact satisfaction scores. Although pathology was found in a similar rate (22% vs. 36% for SIS and HSC groups, respectively), those in the SIS group all required secondary procedures, while only 1/17 did in the HSC group (p < 0.01).

Conclusion: Although the hysteroscopy group exhibited slightly higher pain scores, overall patient and provider satisfaction was high and similar between groups. There were significantly fewer secondary procedures and delays in the hysteroscopy group. Hysteroscopy is a reasonable first line screening tool for patients requiring cavity evaluation.

Trial registration: ClinicalTrials.gov , NCT04415489.

Keywords: Assisted reproduction; Office hysteroscopy; Ultrasound.

Fig. 1

Abnormalities detected with office hysteroscopy and SIS. Top row: retained products of conception, endometrial polyp, intrauterine synechiae, and unicornuate uterus. Bottom row: retained products of conception, multiple polyps, intrauterine synechiae, and intramural fibroid impinging on uterine cavity

Fig. 2

Comparative cavity evaluation. Both subjects were randomized to SIS and received office hysteroscopy after detection of abnormality on the initial screen. Left column depicts endometrial polyp in one patient in SIS (top) and hysteroscopy (bottom). Right column depicts a second patient, with copious circumferential polypoid tissue in SIS (top) and hysteroscopy (bottom)