Abstract
Study Objective: In patients who have planned hysterosalpingography (hsg) for routine infertility workup, investigate the feasibility and potential benefits of simultaneous office hysteroscopy (ofhys) use. Design: Prospective, clinical study. Setting: Tertiary care center affiliated with a school of medicine. Patients: 72 infertile patients were selected for this study. There were no endometrial or adnexal pathology during the initial ultrasound examination. An environment was established for simultaneous use of ofhys and hsg under portable fluoroscopy. Mild sedation or parentheral analgesics were used during the procedure according to the patient's need. Intervention: The ofhys procedure started from introduction of the 4 mm rigid ofhys (Karl Storz, Germany) through the external cervical os, and finished after visualization of the uterine cavity and tubal ostia. If any pathology is detected, appropriate surgical procedure (adhesiolysis, polypectomy, etc.) was carried out with the help of scissors or grasper which passed through the operative channel of ofhys. Before removing the hysteroscope the portable fluoroscopy was adjusted for an appropriate pelvic image, and a hsg was performed by applying contrast media through an irrigation cannula. We recorded the procedural time, and the findings of the combined ofhys and hsg. Measurements and Main Results: While evaluating the combined ofhys-hsg, normal findings were found in 47 patients and pathological findings were found in 25 patients. Procedural time was statistically higher in patients who detected abnormal findings (2.55 ± 1.06 vs 6.82 ± 4.2 minutes respectively, p: .001). Tubal pathology detection rate was 15.3% for hsg. The rate of endometrial pathology detected and corrected during ofhys was 25%.Table 1Combined office hysteroscopy-hysterosalpingoraphy (ofhys-hsg) findingsofhysFrequencyPercentNormal5475Endometritis11.4Polyp1318Synechia34.2Endometrial hyperplasia11.4Total72100hsgFrequencyPercentNormal6184.7Bilateral prox. tubal obst.22.8Unilateral prox. tubal obst811.1Unilat. hydrosalpenks11.4Total72100ofhys: Office hysteroscopy, hsg: Hysterosalpingography. Open table in a new tab ofhys: Office hysteroscopy, hsg: Hysterosalpingography. Conclusion: The combined ofhys-hsg method is not only more reliable for the assessment of tubal and uterine cavity pathologies, but also give an opportunity to treat endometrial pathologies are detected at the same time. Safety, ease of use, shortened time of pre-treatment research of infertility and high patient tolerance may make combined ofhys-hsg method an ideal candidate for the infertility workup.
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