Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
Gillings School of Public Health, University of North Carolina School, Chapel Hill, NC, USA.
J Assist Reprod Genet. 2021 Mar;38(3):627-634. doi: 10.1007/s10815-021-02065-9. Epub 2021 Feb 1.
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.
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.
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).
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.
ClinicalTrials.gov , NCT04415489.
比较生理盐水超声（SIS）与门诊宫腔镜检查用于体外受精（IVF）前宫腔评估的患者和医生满意度，并评估宫腔镜诊断时处理病理的能力，以减少延迟和额外的操作。
这是一项在大学生育诊所进行的随机对照试验。100 名接受计划胚胎移植前常规子宫腔评估的入组患者被随机分为 SIS 组或无麻醉门诊宫腔镜组。患者和医生完成了关于他们体验的调查。SIS 检查结果异常的患者行宫腔镜检查或进一步检查。宫腔镜检查结果异常的患者在同一程序中尝试进行处理。
总体而言，患者满意度较高，且两组间无差异，而医生表示宫腔镜检查提供了更好的宫腔评估。两组之间完成操作的时间无差异。与 SIS 组相比，宫腔镜组的疼痛评分（十分制）略高（3.38±1.85 对 2.44±1.64，p<0.01），但这并未影响满意度评分。尽管 SIS 组和 HSC 组的病理检出率相似（分别为 22%和 36%），但 SIS 组所有患者都需要进行二次操作，而 HSC 组只有 1/17 例需要（p<0.01）。
尽管宫腔镜组的疼痛评分略高，但总体上患者和医生的满意度高且两组间相似。宫腔镜组的二次操作和延迟明显较少。对于需要宫腔评估的患者，宫腔镜是一种合理的一线筛查工具。
ClinicalTrials.gov，NCT04415489。
