What is the role of routine hysteroscopy in the evaluation of uterine cavity in infertile women?

Abstract

The objective was to determine if hysteroscopy associated to endometrial biopsy should be part of the basic routine investigation of infertile women and to study the incidence of intrauterine abnormalities and associated factors. At the Infertility Clinic of the State University of Campinas, 93 infertile women were prospectively investigated by diagnostic hysteroscopy using a 2.7 or 4.0 mm hysteroscope followed by endometrial biopsy. All patients gave their written informed consent. The associated factors studied were: age, reproductive history, previous pelvic surgery, menstrual cycle characteristics and infertility etiology. Statistical analysis was performed by Fisher's test. In 31 patients (33.3%), hysteroscopy showed an important cervical (4.3%) or intrauterine abnormality. Uterine cavity pathologies were: small uterine cavity size(7.5%); submucous leiomyomas of the uterus (6.4%), polyps (6.4%); uterine malformations (5.4%), and enlarged uterine cavity (4.3%). Endometrial histology diagnosed normal endometrium (87%) and 13% of endometrial abnormalities (endometritis, complex hyperplasia, polyps, leiomyoma). The only factor associated with intrauterine pathology was a previous diagnosis of subserous or intramural leiomyoma of the uterus. Hysteroscopic investigation is an important procedure due to the high incidence of intrauterine pathology (one-third of infertile women) and because these diseases could be treated to enhance the fertility rate. Endometrial biopsy should be indicated as a complementary exam after hysteroscopy to improve the accuracy of endometrium evaluation.