The Value of Routine Hysteroscopy Before First Embryo Transfer in Infertile Women With a History of Ectopic Pregnancy: A Propensity Score-Matched Analysis

Background: Ectopic pregnancy is a major early-pregnancy cause of maternal mortality, and hysteroscopy is the gold standard for uterine cavity assessment, offering direct visualization, accurate pathology, easy biopsy, and immediate therapeutic intervention. However, no studies have evaluated whether hysteroscopy improves subsequent pregnancy outcomes in infertile women with a prior ectopic pregnancy. This study aimed to evaluate the necessity of routine office hysteroscopy prior to the first embryo transfer in infertile women with a history of ectopic pregnancy, based on the hypothesis that hysteroscopy may assist in identifying intrauterine pathologies that could impact pregnancy outcomes. Methods: We conducted a single-center retrospective cohort study including consecutive patients with a history of ectopic pregnancy at a university-affiliated hospital between January 2018 and December 2022. Patients were divided into two groups according to whether they underwent hysteroscopy prior to embryo transfer. Propensity score matching (PSM) was applied to balance baseline characteristics between the groups. Results: A total of 714 patients were included in the analysis. Following PSM, no significant differences in baseline characteristics were observed between the two groups. The clinical pregnancy rate was 58.26% in the hysteroscopy group and 53.22% in the non-hysteroscopy group (p = 0.397). Subgroup analysis revealed that patients diagnosed with and treated for chronic endometritis (CE) exhibited a higher spontaneous miscarriage rate (46.90%) and a lower live birth rate (25.00%) compared to the disease-free group (miscarriage rate 18.00%, live birth rate 45.61%), the endometrial polyps (EP) group (miscarriage rate 10.00%, live birth rate 52.31%), and CE + EP group (miscarriage rate 25.00%, live birth rate 44.26%). Conclusions: Routine hysteroscopy prior to first embryo transfer in women with a history of ectopic pregnancy did not significantly improve clinical pregnancy rates. However, hysteroscopy proved valuable in identifying intrauterine abnormalities such as CE and EP, which were associated with adverse reproductive outcomes. Further prospective studies are warranted to determine whether targeted diagnosis and management of these conditions can improve live birth rates in this population.