Table 4.

Characteristics of the nine studies included in group D

Author	Country, year	Study design	Main inclusion criteria	Intervention	Control	Results
Raju et al. (15)	India, 2006	Prospective RCT	520 women undergoing IVF programme	n=255Had office hysteroscopy-Group A (n=160) hadnormalhysteroscopic findings-Group B(n=95) had abnormal office hysteroscopyfindings that were corrected	n=265Without office hysteroscopy	CPR 44.4% (A) 39.5% (B) vs. 26.2% (P<0.05)
Elsetohy et al. (16)	Egypt, 2014	RCT	193 infertile women with no abnormality detected in TVS undergoing ICSI	n= 97 Hysteroscopic examination before ICSI	n=96ICSI without hysteroscopy	PR: 70.1% vs. 45.8% (P=0.001)
Smit et al. (17)	Netherlands, 2016	Multicentre RCT	742 infertile women scheduled to start IVF or ICSI treatment, with normal TVS	n=369 Hysteroscopy prior to IVF(355 completed 18 months of follow-up)	n=373IVF without hysteroscopic examination(353 completed 18 months of follow-up)	OP: 57%vs. 54% (P=0.41)
Aghahosseini et al. (18)	Iran,2012	RCT	353 women undergoing ICSI withtwo or more implantation failuresand:- no uterine cavity abnormalities- normal HSG - age <38 years.	n=142 Hysteroscopy prior to ART	n=211 Immediate ICSI without prior hysteroscopy	CPR: 50.7% vs. 30.3% Delivery rates was 35.5% in the hysteroscopy group and 21.1% in the control group, respectively
El-Toukhy et al. (19)	UK, Italy, Belgium, Czech Republic, 2016	Multicentre RCT		n=367 IVF cycle with prior hysteroscopy	n=352 IVF cycle without prior hysteroscopy	102 (29%) of women in the hysteroscopy group had a livebirth after IVF compared with 102 (29%) women in the control group (risk ratio 1-0.95% CI 0.79–1.25; P=0.96)
Shawki et al. (20)	Egypt, 2012	RCT	719 infertile women younger than 38 years, with two to four failed IVF cycles and planned a further IVF/ICSI cycle	n=105ICSI after office hysteroscopy	n=110ICSI without office hysteroscopy	IR and CPR were statistically significant between the intervention group and control group
Demirol and Gurgan (21)	Turkey, 2004	RCT	225 infertile women with no uterine factor of infertility,abnormal HSG or TVS, previousintrauterine surgery or contraindication for hysteroscopy	n=210Office hysteroscopic before IVF cycles.Group IIa (n = 154) had normalhysteroscopic findings, and group IIb (n = 56) had abnormal hysteroscopic findings	n=211No office hysteroscopic evaluation before IVF cycles	There was a significant difference in the CPR between patients in the control group and group II a (21.6% and 32.5%, P=0.044, respectively) and control group and group IIb (21.6% and 30.4%, P=0.044, respectively)
El-Nashar and Nasr (22)	Egypt, 2011	RCT	421 patients with primary infertility and two or more failed IVF cycles with no uterine cavity abnormalities and normal HSG	n=62 Hysteroscopy with directed biopsy and correction of any intrauterine abnormalities before ICSI	n = 62ICSI cycle without undergoing a hysteroscopy	CPR: 40.3% vs. 24.2% (P<0.05)
Shohayeb and El-Khayat (23)	Egypt, 2012	Prospective RCT	124 infertile women starting their first ICSI cycle 210 infertile womenwith a history of two or more failed ICSI cycles and withnormal thin endometrium	n=105 Hysteroscopy and endometrial scraping in the cycle preceding the ICSI cycle	n=105 Hysteroscopy without endometrial scraping	IR: 12% vs. 7% (P=0.015). CPR: 32% vs. 18 %(P=0.034) BR 28% vs. 14% (P=0.024)

RCT; Randomized controlled trial, PR; Pregnancy rate, TVS; Transvaginal sonography, HSG; Hysterosalpingography, IR; Implantation rate, MR; Miscarriage rate, LBR; Live birth rate, OP; Ongoing pregnancy rate, ICSI; Intracytoplasmic sperm injection, IVF; In vitro fertilization, ART; Assisted reproductive technology, and CPR; Clinical pregnancy rate.