Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a Cochrane Clinical Answer that focuses on the above important clinical question.
Confidence in the evidence is very low or low where GRADE has been performed and there may be no difference in effectiveness between the intervention and comparison for key outcomes. However, this is uncertain and new evidence could change this in the future.
Population: Subfertile women undergoing IVF ᵃ
Intervention: Screening hysteroscopy
Comparison: No hysteroscopy
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Live birth | Favours intervention | Low |
Clinical pregnancy | Favours intervention | Low |
Miscarriage | No statistically significant difference | Low |
Adverse events | No statistically significant difference ᵇ | Very Low |
Note The Cochrane Clinical Answer (CCA) noted that while the intervention produced higher live birth rates and higher clinical pregnancy rates, there was no clear difference between the treatment groups when the analysis was restricted to studies at low risk of bias. It also stated that it is not possible to draw any firm conclusions about the effectiveness of screening hysteroscopy due to the overall low and very low quality of the evidence. ᵃ The CCA noted the population included women undergoing their first IVF treatment, those with one previous treatment failure, those with more than two previous IVF failures, and an unselected IVF population. Subgroup analyses based on the number of previous IVF treatments either reflected the results of the main analysis or were not reported due to being underpowered. ᵇ The Cochrane review which underpins this CCA noted that only four studies reported complications following hysteroscopy, three of which recorded no events in either group. The CCA noted that across the four studies, a single adverse event (endometritis) occurred in a woman undergoing hysteroscopy prior to her first IVF.
This evidence table is related to the following section/s:
Cochrane Clinical Answers
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
- For women undergoing in vitro fertilization (IVF), does prior screening hysteroscopy help to improve outcomes?
- How do ovarian reserve test algorithms for gonadotropin dose selection compare with standard dose for women undergoing in vitro fertilization plus intracytoplasmic sperm injection?
- What are the effects of psychological interventions for subfertile men and women?
- What are the effects of recombinant luteinizing hormone (rLH) and recombinant follicle-stimulating hormone (rFSH) for ovarian stimulation in IVF/ICSI cycles?
- How does ultrasound-guided compare with 'clinical touch'-guided embryo transfer?
- In infertile couples undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI), how does embryo transfer on day three compare with embryo transfer on day two?
- How does letrozole compare with other agents for subfertile women with polycystic ovary syndrome (PCOS)?
- What is the risk of primary ovarian cancer in women undergoing fertility treatment with ovarian stimulation?
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