Does Office Hysteroscopy Add Value in Polycystic Ovary Syndrome Patients With Normal Transvaginal Ultrasound Findings?

Background: This cross-sectional study evaluated the utility of office hysteroscopy in infertile women with polycystic ovary syndrome (PCOS) and normal transvaginal ultrasonography (TVS), compared with unexplained infertility (UI). Methods: Between December 2021 and December 2024, 150 women were enrolled: 100 with PCOS and 50 with UI. All underwent clinical and hormonal assessment, office hysteroscopy, and endometrial sampling. Results: In the PCOS group, hysteroscopy identified a thin endometrium (4%), a tiny polyp (1%), and a sub-septate uterus (1%), while a thin endometrium was found in 8% of UI cases. Vascularity abnormalities and Darwish triad micropolyps were observed in both groups. Histopathology revealed chronic endometritis with micropolyps, disordered proliferative endometrium, and occasional hyperplasia, more frequently in PCOS. Conclusions: No significant clinical correlations were found. Routine hysteroscopy is not recommended in women with normal TVS but may be useful in selected long-standing infertility to detect subtle intrauterine pathology.