Serhat SARIKAYA, Deniz ÖZTEKİN, Ceren SAĞLAM PURUT, Göktürk Han DOĞAN, Anıl Doğukan TUTAL, Yunus Emre PURUT, Alaattin KARABULUT
Pelviperineology - 2026;45(2):73-78
Objective: To evaluate whether diagnostic hysteroscopy performed before a third intrauterine insemination (IUI) cycle improves clinical pregnancy outcomes in women with unexplained infertility after two previous unsuccessful IUI attempts. Materials and Methods: This prospective randomized controlled study included 100 women with unexplained infertility who had undergone two unsuccessful IUI cycles. Participants were randomly allocated into two groups. Women in the hysteroscopy group underwent diagnostic hysteroscopy before the third IUI cycle, whereas women in the control group proceeded directly to the third IUI cycle without hysteroscopic evaluation. The primary outcome was clinical pregnancy rate. Secondary outcomes included the detection of intrauterine pathology and procedure-related complications. Results: Baseline demographic and clinical characteristics were comparable between the groups. Clinical pregnancy was achieved in 10 of 50 women in the hysteroscopy group and 9 of 50 women in the control group, corresponding to pregnancy rates of 20.0% and 18.0%, respectively. The difference was not statistically significant ( p=0.79; relative risk: 1.11, 95% confidence interval: 0.52-2.36). Intrauterine pathology was detected in 3 women (6.0%) in the hysteroscopy group, all of whom had endometrial polyps that were resected during the same procedure. No major hysteroscopy-related complications were observed. Conclusion: Routine diagnostic hysteroscopy before a repeated IUI cycle did not significantly improve clinical pregnancy rates in women with unexplained infertility and previous unsuccessful IUI attempts. Given the low rate of unsuspected intrauterine pathology in this population, hysteroscopy may be more appropriate as a selective rather than routine intervention, particularly in women with abnormal imaging findings or clinical suspicion of intrauterine pathology.
