Antibiotic prophylaxis for hysteroscopy evaluation of the uterine cavity.

OBJECTIVE

To assess the prevalence of infectious complications and the protective effect of prophylactic antibiotic treatment after diagnostic office hysteroscopy in asymptomatic, infertile patients with normal results from transvaginal sonography.

DESIGN

Recording of infectious complications after routine hysteroscopy in the context of a randomized controlled trial; pseudorandomized, center-specific application of antibiotic prophylaxis.

SETTING

Two tertiary infertility care units.

PATIENT(S): Six hundred thirty-one unselected, asymptomatic, infertile women who underwent routine, diagnostic hysteroscopy prior to a first in vitro fertilization (IVF) or intracytoplasmic sperm injection treatment.

INTERVENTION(S): Depending on the hospital and according to local protocols, hysteroscopy was performed with or without antibiotic prophylaxis.

MAIN OUTCOME MEASURE(S): The prevalence of infectious complications after routine hysteroscopy.

RESULT(S): Of the 631 women who underwent routine, diagnostic hysteroscopy, antibiotic prophylaxis was prescribed to 266 women, whereas 365 women underwent the procedure without prophylaxis. Only one infectious complication occurred (0.4%) in a patient who had not undergone therapeutic interventions and had taken antibiotic prophylaxis. This complication was successfully treated with antibiotics on an outpatient basis.

CONCLUSION(S): Considering the extremely low risk of infectious complications and the lack of evidence, suggesting a beneficial effect of antibiotic prophylaxis, its use for routine, diagnostic office hysteroscopy should not be recommended.