Background & Objective: Investigating the impact of COVID-19 on endometrial features in infertile patients through outpatient hysteroscopy provides a deeper understanding of the potential effects of COVID-19 on endometrial structure and function in the context of infertility. This study aimed to evaluate the impact of the COVID-19 pandemic on endometrial features in infertile women undergoing outpatient hysteroscopy in Southwestern Iran.
 Materials & Methods: A retrospective cohort study was conducted in Ahvaz, Southwest Iran, comparing 250 infertile women who underwent hysteroscopy before the pandemic (February 2018–February 2020) with 250 women after the pandemic onset (March 2020–February 2022). Endometrial morphological characteristics, including vascularity, uniformity, and presence of lesions, were assessed. The two groups were compared using independent-samples t-tests and chi-square tests.
Results:  The study revealed significant increases in endometrial abnormalities following the COVID-19 pandemic. Hemorrhagic lesions rose from 0.40% to 10.40% (p < 0.001), punctate spots increased from 0.40% to 18.00% (p < 0.001), and diffuse endometrial patches appeared in 19.20% of post-pandemic patients but were absent pre-pandemic (p < 0.001). Among post-pandemic patients, endometrial abnormalities were most prevalent in those with less than six months between COVID-19 infection and hysteroscopy, although associations were not statistically significant.
Conclusion:  The findings suggest that the COVID-19 pandemic may have contributed to notable changes in endometrial morphology among infertile women, potentially due to systemic effects of SARS-CoV-2 or indirect consequences of healthcare disruptions during the pandemic. Further longitudinal and multicenter studies are needed to elucidate the underlying mechanisms and long-term reproductive health implications of these changes.