Routine office hysteroscopy in the investigation of infertile couples before assisted reproduction (original) (raw)

Evaluation of Hysteroscopy in Infertile Patients

European Archives of Medical Research

The aim of this study was to evaluate the hysteroscopy results in infertile patients and to compare the clinical pregnancy, live birth and abortion rates between patients with uterine cavity abnormalities treated with operative hysteroscopy and patients with normal uterine cavity. Methods: Three hundred and nineteen patients who underwent hysteroscopy for infertility between January 2010 and December 2015 were included in the study. The patients were divided into two main groups: diagnostic and operative. The patients who had normal uterine cavity in exploration and who did not require surgical intervention were referred as diagnostic hysteroscopy group. Patients who underwent surgical intervention during the procedure were named as operative hysteroscopy group. The operative hysteroscopy group was divided into groups as endometrial polyp, submucous myoma, septum, adhesions and T-shaped uterus. Demographic data, laboratory parameters and pregnancy outcomes after hysteroscopy were recorded. Clinical pregnancy, live birth and abortion rates were compared between the groups. Results: The demographic and laboratory characteristics of the diagnostic (n=74) and operative hysteroscopy (n=245) groups were similar. After operative hysteroscopy, 53.9% of the patients had clinical pregnancy and 41.3% of them had live birth. In the diagnostic hysteroscopy group, the clinical pregnancy rate was 55.2% and the live birth rate was 41.7%. There was no significant difference between the two groups in terms of clinical pregnancy and live birth rates. In addition, there was no difference between the two groups in terms of pregnancy acquisition methods and mean duration of conception. In the operative hysteroscopy subgroups, the highest rates of clinical pregnancy and live birth were in patients undergoing endometrial polyp and septum resection, and abortion rates were highest in T-shaped uterus and septum resection groups. Conclusion: We concluded that treatment of uterine cavity pathologies with operative hysteroscopy in infertile patients provided similar clinical pregnancy and live birth rates to patients who have normal uterine cavity.

Office Hysteroscopy in Infertility

Background: For patients undergoing in vitro fertilization, lower pregnancy rates are observed in the presence of uterine cavity anomalies and correction of these anomalies has been associated with improved pregnancy rates. Office hysteroscopy has been proven to have superior sensitivity and specificity in evaluation of the endometrial cavity. Diagnostic hysteroscopy can be performed in an office with minimal discomfort and at a much lower cost than in an operating room. Our study was done to evaluate the importance of office hysteroscopy in diagnosis of pathology in normal appearing infertility work up. Materials and Methods: This study was performed from September 1, 2006 till September 1, 2008 at Imam Khomayni hospital, Ahwaz, Iran. All infertile patients who had unexplained infertility or uterine factor infertility were enrolled in the study and underwent office hysteroscopy. The participants were divided into two groups. Group one was composed of 54 patients with unexplained in...

Hysteroscopy and female infertility: a fresh look to a busy corner

Human Fertility, 2020

Hysteroscopy has evolved from the traditional art of examining the uterine cavity for diagnostic purposes to an invaluable modality to concomitantly diagnose and (see and) treat a multitude of intrauterine pathologies, especially in the field and clinics specialising in female reproduction. This article reviews the literature on the most common cervical, endometrial, uterine and tubal pathologies such as chronic endometritis, endometrial polyps, adenomyosis, endometriosis, endometrial atrophy, adhesions, endometrial hyperplasia, cancer, and uterine malformations. The aim is to determine the efficiency of hysteroscopy compared with other available techniques as a diagnostic and treatment tool and its association with the success of in vitro fertilisation procedures. Although hysteroscopy requires an experienced operator for optimal results and is still an invasive procedure, it has the unique advantage of combining great diagnostic and treatment opportunities before and after ART procedures. In conclusion, hysteroscopy should be recommended as a first-line procedure in all cases with female infertility, and a special effort should be made for its implementation in the development of new high-tech procedures for identification and treatment infertility-associated conditions.

Is hysteroscopy a routine investigation before assisted reproductive techniques

Caspian Journal of Reproductive Medicine , 2015

Background: Infertility is a common problem as it is observed in 10-15% of couples to whom developing approaches for treatment is an issue of utmost importance. The aim of the current study was to determine the accuracy of diagnostic transvaginal ultrasongraphy (TVS) for the investigation of uterin pathologies in women before the application of assisted reproductive technique (ART). Methods: In this observational, cross-sectional study, TVS and diagnostic hysteroscopy were performed consecutively on 100 infertile women, who were candidates for ART. All the findings of TVS were compared with hysteroscopic appearance of uterine cavity. The sensitivity, specificity, and positive and negative likelihood ratios were also calculated for diagnostic polyp and uterine anomalies. Results: Polyp was detected through diagnosis hysteroscopy in 6 cases (6.0%), out of whom 4 were diagnosed by TVS. The sensitivity and specificity ratios with TVS, diagnosed for polyp, were 50.00% and 98.94%, respectively. In addition, the sensitivity and specificity ratios with TVS, diagnosed for uterine abnormalities were 27.78 % and 98.78%, respectively. Conclusion: The researchers concluded that TVS allows for the diagnosis of polyp uterine in the most cases, but its sensitivity for diagnosis of uterine anomalies is low. Therefore, TVS is not useful technique, compared with hysteroscopy, in patients who are candidates for ART. Thus, hysteroscopy is highly recommended.

Role of hysteroscopy prior to assisted reproductive techniques

Journal of Gynecological Endoscopy and Surgery, 2009

Background: There have been numerous advances in the area of assisted reproduction. Among the various reasons of implantation failure, intrauterine lesions play an important role. Objective: The aim of the present study is to evaluate the role of hysteroscopy prior to any assisted reproductive technique. Materials and Methods: It is a retrospective study of 292 women who attended our infertility clinic over a period of 18 months, who had a variable number of failed IVF cycles previously. Results: Out of the 292 women studied, in 74 women, that is 25%, intrauterine pathology was detected, which when rectifi ed by hysteroscopy, gave a considerable increase in pregnancy rate. Conclusion: According to this study it can be concluded that evaluating the uterine cavity is an important step before any assisted reproductive procedures.

Diagnostic hysteroscopy as a primary tool in a basic infertility workup

Jsls Journal of the Society of Laparoendoscopic Surgeons Society of Laparoendoscopic Surgeons, 2006

Objective: To assess the value of diagnostic hysteroscopy in a primary workup of infertility. Methods: We performed a retrospective analysis (Canadian Task Force Classification II-2) of 221 infertile patients referred to the Outpatient Center for Uterine Cavity Evaluation and the Tel-Aviv University affiliated Assaf Harofe Medical Center for evaluation of the uterine cavity. Patients underwent a diagnostic office hysteroscopy. Results: Hysteroscopy revealed an abnormal uterine cavity in 30% of women evaluated for either primary or secondary infertility. No significance was found regarding the total number of intrauterine pathologies when comparing the groups of primary versus secondary infertility. Conclusion: Routine diagnostic hysteroscopy should be part of an infertility workup in primary and secondary infertility.

Hysteroscopic Evaluation in Infertile Females: Hospital Based Prospective Study

International Journal of Advanced Medicine, 2020

A couple is generally considered infertile if they are unable to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. Hysteroscopy is a valuable diagnostic and therapeutic modality in the management of infertility. Today, it is considered the gold standard for evaluating the uterine cavity. The aim of our study is to describe hysteroscopy findings in 200 infertile females and to compare its use in primary versus secondary infertility. A hospital based prospective cross-sectional study, was conducted in the department of Obstetrics and Gynaecology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, from Jan 2019 to Nov 2019, which included 200 infertile females undergoing diagnostic hysteroscopy. Hysteroscopic abnormalities were noted and analysed using appropriate statistical test and if needed endometrial biopsy were send along with any operative procedure was done. Mostly no abnormality was detected on hysteroscopy in uterine cavity, internal os and endometrium in both patients of primary and secondary infertility. Most common uterine cavity abnormality in both groups was intrauterine adhesion along with congested endometrium. Most of the uterine abnormalities were treated either in the same or subsequent operating setting. Hysteroscopy is cost-effective, comprehensive and gold standard for evaluation of uterine cavity in infertility patients since it aids not only in diagnosing the pathology but also its simultaneous management.

Results of 2500 office-based diagnostic hysteroscopies before IVF

Reproductive biomedicine online, 2010

The aim of the study is to assess the diagnostic accuracy, findings and feasibility of office-based diagnostic hysteroscopy in an IVF population. A total of 2500 consecutive infertile patients were enrolled prospectively prior to IVF treatment. Diagnostic hysteroscopy was performed on each subject in an office setting in the study IVF centre. A total of 1927 patients (77.1%) had a normal uterine cavity, while the remainder of the sample (n=573) demonstrated endometrial pathology on hysteroscopy (22.9%). Of the patients with endometrial pathology, 192 patients had endometrial polyps (7.68%), 96 patients had submucosal fibroids (3.84%), 31 patients had polypoid endometria (1.24%), 27 patients had intrauterine adhesions (1.08%) and 73 patients had uterine septa (2.92%). Diagnostic office-based hysteroscopy is routinely performed in the IVF clinic to assess the endometrial cavity. In such an unselected population, a significant percentage of patients had evidence of uterine pathology th...

Role of Hysteroscopy in Infertility – A Retrospective Study

International journal of Gynecology, Obstetrics and Neonatal Care, 2017

The aim of this study is to assess the results of hysteroscopy done in cases of infertility. Objective: To determine the incidences of abnormal findings of hysteroscopy in evaluation of infertility. Material and Methods: This retrospective observational study was carried out at department of Gynaecology AVBRH, sawangi, over a period of six months from October 2016 to March 2017. After detailed clinical evaluation, all patients of infertility and subinfertility, irrespective of their obstetric history, coming to AVBRH, sawangi were informed regarding the procedure and written informed consent was taken. Hysteroscopy was performed in operation theatre by using KARL STORZZ hysteroscope. It is a rigid continuous flow panoramic hysteroscope 25 cm in length, 5 mm diameter of an outer sheath and 30° fibroptic lens. All procedures were done under general anaesthesia. Distension of uterine cavity was achieved with normal saline by pressure bag or Endomat. Endocervical canal followed by whole uterine cavity with all four walls and bilateral ostias were visualised. Endometrial biopsy was taken for histopathological examination under direct vision if required. If any pathology like intrauterine adhesions, polyp, myoma or septa was diagnosed, operative procedure was done at the same sitting. Data was collected from the medical records department of the hospital. Statistical analysis was done by using descriptive and inferential statistics using z-test for single proportion and software used in the analysis were SPSS 17.0 version and EPI-INFO 6.0 version and z>1.96 considered as significant. Results: Hysteroscopy was performed in 85 infertile women, out of which 61 (71.76%) presented with primary infertility and 24 (28.24%) women were with secondary infertility. Analysis was performed against primary and secondary infertility.

Hysteroscopy: An Essential Tool in the Workup of Infertility

International Journal of Infertility & Fetal Medicine

for the success of IVF procedure in cases of recurrent implantation failure. Many physicians still regard hysteroscopy as just a supplementary test in case of abnormal findings detected by other methods (primarily HSG and ultrasound). So this study was conducted to establish the role of diagnostic hysteroscopy as a primary integral tool in the workup of infertility.