Hysteroscopy as investigating-operative procedure in primary and secondary infertility: a systematic review

Objective: the aim of this study is to review current indications to diagnostic and/ or operative hysteroscopy in primary and secondary infertility, as well as to determine its efficacy in improving fertility. Study design: we gather the available evidence concerning the role of hysteroscopy in the management of various infertility condtitions. Literature about the topic from 2000 to 2020 was retrieved and appropriately selected. Results: hysteroscopy does not appear as a first line diagnostic procedure for every clinical scenario. However, its diagnostic sensitivity and specificity in assessing intrauterine pathology is superior to all other non-invasive techniques, such as saline infusion/gel instillation sonography (SIS/GIS), transvaginal sonography (TVS) and hysterosalpingography (HSG). Hysteroscopy allows not only a satisfactory evaluation of the uterine cavity but also, the eventual treatment of endocavitary pathologies, that may affect fertility both in spontaneous and assisted reproductive technology (ART) cycles. Conclusions: hysteroscopy, due to its diagnostic and therapeutic potential, should be regarded as a necessary step in infertility management. However, in case of suspected uterine malformation, hysteroscopy should be integrated with other tests (3D ultrasound or MRI) for the diagnostic confirmation.