Hysteroscopic Findings Research Articles

Effect of Ksheerbasti and Uttara Basti on Endometrial Fibrosis Induced Infertility (Kshetra Dushti Janya Vandhyatva) - A Case Report

Infertility is a disease of male or female, defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse. Fibrous scaring of the uterine cavity not only decreases fertility (via impairing embryo implantation) but is also associated with an increased risk of miscarriage and other obstetric conditions. Here is a case study of a 30-years-old female patient residing in Jaipur who consulted in OPD of the National Institute of Ayurveda (NIA) Jaipur on 30-9-23 with the chief complaint of being unable to conceive since 5 years. Her diagnostic Laproscopy & Hysteroscopic findings were suggestive of multiple subserosal fibroid & fibrosed endometrium. Patient was treated with Ayurvedic regime for 5 cycle considered as a Kshetra Dusthi Janya Vandhyatva. The patient missed her period on 8-03-24 and did her urine pregnancy test on 19-3-24, which was found to be positive. From this case study, it is concluded that Ayurvedic intervention are effective in treating infertility due to Endometrial Fibrosis (Kshetra Dushti Janya Vandhyatva).

Nonlinear correlation between serum vitamin D levels and the incidence of endometrial polyps in infertile women.

Are serum vitamin D levels associated with the incidence of endometrial polyps (EPs) in infertile patients? Serum 25(OH)D levels were nonlinearly correlated with the incidence of EPs in infertile women. EPs are a common condition that may affect the receptivity of the endometrium in women of reproductive age. Vitamin D regulates cell proliferation and differentiation, apoptosis, angiogenesis, anti-inflammation, and immunomodulation, in addition to its well-known functions in balancing calcium and phosphorus. Previous studies have shown that vitamin D concentrations are associated with reproductive outcomes, and that low vitamin D levels are associated with the incidence of colorectal polyps and nasal polyps. There is little evidence regarding the relationship between EPs and serum vitamin D levels. We conducted a cross-sectional study using data from Guangdong Women and Children Hospital from January 2019 to October 2023, enrolling 3107 patients. A total of 3107 infertile patients who underwent hysteroscopy were included in this study; 642 patients had endometrial polyps and 2465 had a normal uterine cavity. Hysteroscopy findings included risk of EPs, polyp size, percentage of multiple polyps, and incidence of chronic endometritis (CE). Serum vitamin D were assessed by measuring total 25(OH)D using chemiluminescence. According to international guideline recommendations for vitamin D deficiency, patients were divided into two groups: the <50 nmol/l group and the ≥50 nmol/l group. Univariable and multivariable logistic regression models, stratified analyses, and smooth curve fitting were used to examine the relationship between serum 25(OH)D levels and risk of EPs. Of all patients, 23.8% (740/3107) were vitamin D deficient (<50 nmol/l). The incidence of EPs was significantly higher in the 25(OH)D < 50 nmol/l group than in the ≥50 nmol/l group (24.9% vs 19.3%; P = 0.001). However, there were no differences in polyp size, proportion of multiple polyps, and presence of CE between the two groups. After controlling for confounders, 25(OH)D ≥ 50 nmol/l (compared with <50 nmol/l) was negatively associated with risk of EPs (adjusted OR, 0.733; 95% CI, 0.598-0.898). Other variables that had an impact on polyp incidence included BMI, type of infertility, CA125, and CD138-positive plasma cells. In addition, a linear regression model between age and serum 25(OH)D levels showed a positive linear association. Subgroup analyses were performed for different age groups, and the risk of EPs was significantly higher in the 25(OH)D < 50 nmol/l group than in the ≥50 nmol/l group, both in the younger subgroup (23.8% vs 19.1%) and in the older subgroup (28.0% vs 19.9%). The smooth curve fitting model showed a nonlinear correlation between 25(OH)D levels and risk of EPs (nonlinear P-value = 0.020), with an optimal threshold of 51.8 nmol/l for 25(OH)D levels. Moreover, subgroup smooth curve fitting models showed a nonlinear correlation between 25(OH)D levels and polyp risk in patients aged <35 years (nonlinear P-value = 0.010), whereas a linear correlation between 25(OH)D levels and polyp risk was found in patients aged ≥35 years (nonlinear P-value = 0.682). Caution should be exercised in interpreting our findings as this is a correlational study and causality cannot be inferred from our results. In addition, because of strict inclusion and exclusion criteria, our results may not be generalizable to unselected populations, including premenopausal women or women of other races. This study demonstrated for the first time that vitamin D deficiency is an independent risk factor for the incidence of EPs in infertile patients. Identifying modifiable risk factors (e.g. vitamin D deficiency) can help in the development of new strategies for treating polyps or to protect against polyp development. Further clinical intervention trials and laboratory studies are needed to evaluate the effect of vitamin D on the development of EPs and to elucidate the mechanisms. The study was funded by the National Natural Science Foundation of China (82101718) and Natural Science Foundation of Guangdong Province, China (2022A1515010776). No competing interest was involved in this study. N/A.

Justification of the necessity, value, and role of diagnostic hysteroscopy in the management plan for abnormal uterine bleeding. A teaching hospital experience

Aims: The crucial purpose of this study is to pay thoughtfulness to the filmic inspection of the uterine cavity and circumstantial operative amenities have provided the gynecologist with the perfect 'diagnostic' tool, making it conceivable to inspect the cavity and biopsy distrusted areas under direct visualization for patients presented with abnormal uterine bleeding AUB in the perimenopausal or postmenopausal periods. Materials and methods: We retrospectively reviewed the medical records of 123 perimenopausal and postmenopausal women who presented with abnormal uterine bleeding (AUB) at Jordan University Hospital (JUH) between January 1, 2022, and August 1, 2024. Participants underwent diagnostic hysteroscopy followed by endometrial biopsy. The hysteroscopic findings were compared with the final histopathological diagnoses to evaluate diagnostic accuracy. Results: In this study of 123 women, clinical indications for hysteroscopy differed by menopausal status, with heavy menstrual bleeding being the most common indication among premenopausal women (74.6%), while postmenopausal bleeding was predominant in postmenopausal women (80.8%). Hysteroscopy revealed a regular uterine cavity in 92.7% of cases, with endometrial abnormalities such as thickened or thin endometrium observed in a significant number of women. Histopathological analysis found normal endometrium in 47.2% of cases, with endometrial polyps (16.3%) and other conditions such as hormonal imbalance and endometritis also frequently noted. A significant relationship was observed between menopausal status and both uterine cavity condition (p = .025) and endometrial state (p = .002), with postmenopausal women more likely to exhibit a thin or abnormal endometrium. The diagnostic value of hysteroscopy was high for fibroids (100% detection) but lower for endometrial polyps (50% detection). Conclusion: Hysteroscopy must be used as the second-line diagnostic tool after vaginal ultrasound assessment for evaluating the endometrial status in cases of AUB and a necessary step before the decision of surgical removal of the uterus. However, hysteroscopy is not very reliable for ruling out endometrial hyperplasia or cancer in women who have postmenopausal bleeding. Because of this, an endometrial biopsy is crucial for an accurate diagnosis.

Correlation of hysteroscopic findings of chronic endometritis with CD138 immunohistochemistry and their correlation with pregnancy outcomes.

To investigate the correlation between hysteroscopic findings of chronic endometritis and CD138 immunohistochemistry positive in endometritis and to analyze the pregnancy outcomes and associated risk factors following embryo transfer in women diagnosed with chronic endometritis via hysteroscopy. A retrospective observational study carried out at the Reproductive Medicine Center of Tangdu Hospital of Air Force Medical University, from January 2021 to December 2021, was performed by obtaining data from 194 medical records of women who underwent hysteroscopies for infertility and were diagnosed with chronic endometritis based on Delphi criteria. Spearman correlation analysis was used to evaluate the correlation between hysteroscopic findings and endometrial CD138 immunohistochemistry. The study also observed the differences in relevant indexes between the CD138-positive and CD138-negative groups after embryo transfer and analyzed factors influencing implantation failure using logistic regression analysis. The correlation analysis between hysteroscopic findings and CD138 immunohistochemistry showed that micropolyps were correlated with CD138 immunohistochemistry positivity. The correlation coefficient was 0.32 (P < 0.01). After embryo transfer, the clinical pregnancy rate of the CD138-positive group was lower compared to that of the CD138-negative group [64.79% (46/71) vs. 81.30% (100/123), P < 0.05]. The results of the multivariate logistic regression analysis revealed that age (P = 0.43) and CD138 immunohistochemistry positivity (P = 0.008) were the independent risk factors for predicting whether or not embryo implantation was successful. Hysteroscopic findings do not correlate strongly with endometrial CD138 immunohistochemistry, and chronic endometritis cannot be diagnosed by hysteroscopy alone. CD138 immunohistochemistry positivity is an independent factor contributing to the decrease in clinical pregnancy rate following embryo transfer.

Revolutionizing chronic endometritis diagnosis: real-time polymerase chain reaction unveils microbial pathogens in Indian women with abnormal bleeding and reproductive challenges

BackgroundThis study aimed to assess the utility of real-time-polymerase chain reaction (PCR) for diagnosing chronic endometritis (CE) by targeting 11 prevalent pathogens and to compare the outcomes with conventional culture-based diagnosis. Study DesignA retrospective analysis was conducted on 500 patients with clinical conditions such as abnormal bleeding, in vitro fertilization failure, recurrent implantation failure, recurrent miscarriage, and recurrent pregnancy loss. The prevalence of 11 key pathogens associated with CE was evaluated in endometrial biopsy samples. ResultsIn our study, PCR identified 318 cases (63.6%) positive for at least one of the 11 investigated pathogens, while culture-based methods detected 115 cases (23%). Predominant pathogens detected by PCR included Enterococcus faecalis (E. faecalis) (19%), Escherichia coli (E. coli) (6.8%), Staphylococcus aureus (S. aureus) (9%), Mycoplasma hominis (5%), Mycoplasma genitalium (6.2%), Streptococcus agalactiae (S. agalactiae) (4.2%), Ureaplasma urealyticum (4%), nontuberculous Mycobacterium (5.2%), Mycobacterium tuberculosis (1.2%), Neisseria gonorrhoeae (0.6%), and Chlamydia trachomatis (2.4%). Standard culture methods identified E. faecalis (10.8%), S. aureus (6.2%), E. coli (3.8%), and S. agalactiae (2.2%). ConclusionThe DICE panel proves itself as a swift, precise, and cost-effective diagnostic tool for detecting both culturable and nonculturable endometrial pathogens in CE. Demonstrating superiority, the Molecular method outshines microbial culture, ensuring accurate and sensitive detection of CE-associated pathogens, harmonizing seamlessly with histology and hysteroscopy findings.

P-302 Oral ofloxacin combined with vaginal metronidazole for chronic endometritis: a prospective open-label cohort study

Abstract Study question Does oral ofloxacin 2x200 mg for 10 days combined with vaginal metronidazole 1x500 mg for 10 days reduce the activity of chronic endometritis? Summary answer The investigated antibiotics may be beneficial in some cases of chronic endometritis, except in cases of concomitant endometrial polyp, where they adversely affect treatment outcome. What is known already Chronic endometritis (CE) is characterized by the presence of atypical plasma cell infiltrates (CD138 positive) in the endometrial stroma. CE may adversely affects fertility by reducing endometrial receptivity, impairing decidualization and uterine contractility, thus increasing the risk of recurrent pregnancy loss and implantation failure. Some idiopathic infertility cases are attributed to CE. The diagnostics of CE is challenging because the clinical evaluation is nonspecific and the immunohistochemical criteria are not consistent between research centers. Literature data suggested that successful treatment of CE with antibiotics could improve live birth rates, but a preferred treatment regimen has not been identified. Study design, size, duration A prospective cohort study included women undergoing office hysteroscopy (OH) at a tertiary referral center in 2021-2023. Women diagnosed with CE were assigned, based on their preference, to the intervention arm of ofloxacin 2x200 mg orally for 10 days + metronidazole 500 mg vaginally for 10 days or to the control arm (no antibiotics). 100 women underwent repeated hysteroscopy after 3 cycles, of which 77 received antibiotics and 23 were controls. Participants/materials, setting, methods Women aged 18-45 who met eligibility criteria for OH were included. Karl Storz 5.0 mm Bettocchi® operating sheath with a 2.9 mm 30° telescope and a 5Fr working channel was used. Endometrial lesions or biopsy specimens were collected with grasping forceps, blunt scissors or bipolar needle electrode. Saline was used as the dilating medium. Tissue samples were subjected to histopathological examination. Plasma cells were detected by immunohistochemical staining with Monoclonal Mouse Anti-Human CD138 antibodies. Main results and the role of chance The most common findings identified at hysteroscopy were endometrial polyps (43%), polypoid endometrium (38%), micropolyps (23%), focal (27%) and diffuse hyperemia (18%) and cesarean scar defect (14%). CE was defined as the presence of &amp;gt; 2 plasma cells/mm2. The Mann-Whitney U test showed a significantly higher plasma cell count (PCC) in the presence of a cesarean scar defect than in other cases (23 vs. 18/mm2, p = 0.031) and a tendency towards a lower PCC in micropolyps (9 vs. 21/mm2, p = 0.063). The correlation of hysteroscopic findings with CE activity was weaker than expected. Using repeated measures ANOVA, no difference in PCC between primary and follow-up hysteroscopy was found in either arm (p = 0.8), while post-hoc tests showed that the mean PCC decreased from 12 to 5/mm2 (p = 0.02) in the intervention arm, and from 14 to 6 (p = 0.23) in the control arm. On follow-up hysteroscopy, polyp remission was observed significantly more often in the control arm than in the intervention arm (61% vs. 27%, pChi2=0.02), in which de novo polyp was observed in 4%. In polypoid endometrium, the remission rate was similar in both arms (19% vs. 22%), and the rate of de novo lesions was significantly lower in interventional arm (16% vs. 39%, pChi2=0.035). Limitations, reasons for caution The limitations include the small sample size, the CE definition based on the number of plasma cells calculated using the Receiver Operating Characteristic curve for the purposes of the study, and the empirical selection of antibiotic therapy. Wider implications of the findings Due to the weak correlation of hysteroscopic findings with CE activity, the diagnostics and treatment of CE based on clinical evaluation of the uterine cavity is not justified. Poorly selected antibiotic therapy may adversely affect the outcomes of treatment. Trial registration number 1072.6120.322.2020

Diagnostic Efficacy of Hysteroscopy and Its Use as a Therapeutic Aid in Perimenopausal and Postmenopausal Women – See and Treat

ABSTRACT Aim: The aim of this study was to study the therapeutic role of hysteroscopy in peri- and postmenopausal women in certain pathological conditions, where it can be done as a single-time procedure to diagnose and operate wherever needed and possible. Objective: The objective of this study was to measure the diagnostic accuracy of hysteroscopy and its therapeutic efficacy in peri- and postmenopausal women. Introduction: Hysteroscopy is one of the accurate diagnostic procedures in diagnosing the cause of peri- and postmenopausal bleeding (PMB). It can also be used to treat few benign conditions of peri- and PMB. Here, in our study, we tried to evaluate the accuracy of hysteroscopy in diagnosing the cause of peri- and PMB and its use in treating certain conditions of PMB. Materials and Methods: The study design is a prospective observational study; women with peri- and PMB were recruited for 1 year and followed for consecutive 3 years. Based on hysteroscopic findings and after confirming the histopathological examination report, women were treated. Women who did not need any further surgical procedures after operative hysteroscopy were followed for recurrence in benign conditions. Women with premalignant and malignant lesions underwent simple or radical hysterectomy soon after diagnosis. Results: A total of 71 women were enrolled in the study who fulfilled the inclusion criteria. There were 20 perimenopausal and 51 postmenopausal women, the mean age was 56.02 years. Most of the women presented with PMB (56.3%) or heavy menstrual bleeding (18.3%). Hysteroscopy has 83.34%, 100%, 100%, 98.46%, and 0.98% of sensitivity, specificity, positive predictive value, negative predictive value, and accuracy, respectively, in diagnosing carcinomas. Out of 71 women, 58 were diagnosed with benign conditions, 6 had carcinoma, 7 had premalignant conditions, these 13 women with malignant or premalignant conditions underwent further surgical management as per protocol. 58 women who did not need any further surgical procedure, and hysteroscopy was sufficient to treat their condition were followed up for 3 consecutive years, 4 had recurrence of endometrial polyps, 6 had recurrence of bleeding and needed hysterectomy, thus in our study by means of hysteroscopy we could prevent hysterectomy in 67.7% of women with benign endometrial conditions. Conclusion: In conditions with benign endometrial polyps and fibroid polyps, hysteroscopy is very much useful for both diagnosis and treatment, which can be performed as a one-time procedure. Although this serves the purpose only in a small segment of women with peri- and PMB, it is needed in the prevention of unnecessary hysterectomies.

Correlation between hysteroscopic features and specific microbial species in women with chronic endometritis

Objective and rationaleChronic endometritis (CE) has recently been associated with unexplained infertility and recurrent miscarriages. The current gold standard for CE detection is histopathological examination. However, office hysteroscopy and endometrial cultures are also significant, due to the possible link between CE and various microorganisms. Bacterial colonization of the endometrium has been associated with reduced success rates of in vitro fertilisation embryo transfer. Few studies have tried to correlate CE hysteroscopy findings with pathogenic microorganisms. This prospective cohort study sought to establish whether hysteroscopic diagnostic lesions correlate with specific microbial species. MethodsThe study encompassed women undergoing diagnostic tests for a range of subfertility health issues. 189 women completed the standard office diagnostic hysteroscopy (DH). 181 had also endometrial samples taken for microbial culture investigation. Correlation analysis (χ2 and Fisher's exact test) between hysteroscopic findings suggestive of CE and endometrial cultures was carried out. Logistic regression models were also fitted to measure whether a positive endometrial culture could affect CE conditions. ResultsA significant association of E. coli was observed between the hysteroscopically characterized CE + group with focal hyperplasia, when compared to the non–CE group. Logistic regression analysis revealed that women positive for E. coli were 4.423 times more likely to have focal endometrial hyperplasia. No other significant correlations were identified between DH and positive endometrial cultures. ConclusionsThe presence of E. coli in the endometrium was significantly correlated with focal hyperplasia findings from hysteroscopy, emphasizing the importance of microbial cultures in the diagnosis and targeted treatment of CE in women with subfertility.

Clinical utility of office hysteroscopy following failed invitro fertilization-embryo transfer: A retrospective cohort study.

Despite its widespread use, invitro fertilization (IVF) outcomes are challenged by implantation failure, largely due to factors such as embryo quality and endometrial receptivity. In this study, we investigated the clinical effect of office hysteroscopy (OH) on the subsequent frozen-thawed embryo transfer (FET) in infertile women who experienced a failed IVF-embryo transfer (IVF-ET) cycle. We included 577 infertile women who underwent OH because of a history of failed ET between October 2019 and September 2021. During OH, visible endometrial polyps (EPs) were diagnosed and removed by curette or biopsy forceps; chronic endometritis (CE) was diagnosed by histopathology and immunohistochemistry and treated with oral doxycycline (0.2 g/d) for 14 days. According to the hysteroscopic findings and endometrial pathology with immunohistochemistry, patients were divided into three groups: group A (n = 161) had CE with or without EPs, group B (n = 156) had EPs only, and group C (n = 260) had no CE or EPs. In the following FET cycle, the implantation rates were 47%, 51%, and 45% (P = 0.411); the clinical pregnancy rates were 56%, 62%, and 55% (P = 0.436); the live birth rates were 45%, 51%, and 42% (P = 0.205); and the miscarriage rates were 18%, 16%, and 22% (P = 0.497) in groups A, B, and C, respectively. There were no significant differences among groups (P > 0.05). OH is helpful for diagnosis and treatment of abnormal intrauterine environment in women with a failed IVF cycle and further improves their pregnancy outcome in the following FET.

Outpatient hysteroscopy impact on subsequent assisted reproductive technology: a systematic review and meta-analysis in patients with normal transvaginal sonography or hysterosalpingography images

BackgroundStandard management for intrauterine lesions typically involves initial imaging followed by operative hysteroscopy for suspicious findings. However, the efficacy of routine outpatient hysteroscopy in women undergoing assisted reproductive technology (ART) remains uncertain due to a lack of decisive high-quality evidence. This study aimed to determine whether outpatient hysteroscopy is beneficial for infertile women who have unremarkable imaging results prior to undergoing ART.MethodsA systematic review and meta-analysis were conducted following PRISMA guidelines, incorporating data up to May 31, 2023, from databases such as PubMed, Embase, and the Cochrane Library. The primary outcome assessed was the live birth rate, with secondary outcomes including chemical pregnancy, clinical pregnancy rates, and miscarriage rates. Statistical analysis involved calculating risk ratios with 95% confidence intervals and assessing heterogeneity with the I2 statistic.ResultsThe analysis included ten randomized control trials. Receiving outpatient hysteroscopy before undergoing ART was associated with increased live birth (RR 1.22, 95% CI 1.03–1.45, I2 61%) and clinical pregnancy rate (RR 1.27 95% CI 1.10–1.47, I2 53%). Miscarriage rates did not differ significantly (RR 1.25, CI 0.90–1.76, I2 50%). Subgroup analyses did not show a significant difference in clinical pregnancy rates when comparing normal versus abnormal hysteroscopic findings (RR 1.01, CI 0.78–1.32, I2 38%). We analyzed data using both intention-to-treat and per-protocol approaches, and our findings were consistent across both analytical methods.ConclusionsOffice hysteroscopy may enhance live birth and clinical pregnancy rates in infertile women undergoing ART, even when previous imaging studies show no apparent intrauterine lesions. Treating lesions not detected by imaging may improve ART outcomes. The most commonly missed lesions are endometrial polyps, submucosal fibroids and endometritis, which are all known to affect ART success rates. The findings suggested that hysteroscopy, given its diagnostic accuracy and patient tolerability, should be considered in the management of infertility.Database registrationThe study was registered in the International Prospective Register of Systemic Review database (CRD42023476403).

Role of hysteroscopy in categorization of abnormal uterine bleeding in a multispecialty hospital in Bahrain

Background. Abnormal uterine bleeding is a broad term involving various irregularities of the menstrual cycle. Previously various terms were used to define abnormalities in menstrual bleeding. To create a universally accepted system of nomenclature, the Federation of Obstetrics and Gynecology proposed the new terminology PALM-COIEN. The current study is aimed to classify cases of abnormal uterine bleeding as per PALM-COEIN. Materials and Methods. It is a retrospective, observational study using the data from 110 patients, who underwent hysteroscopic evaluation and endometrial biopsy and were categorized based on PALM-COIEN. Patients were grouped under these categories after detailed history, examination, investigations, hysteroscopic findings, and histopathology. Results. Polyp was the commonest group (n=45, 40.9%) in our study, which was followed by leiomyoma (n=30, 27.27%), ovulatory disturbances (n=28, 25.45%), adenomyosis (n=5, 4.54%), malignancy (n=2, 1.81%) respectively. Conclusions. Hysteroscopic evaluation is a simple and useful tool to find out the structural pathologies of PALM-COIEN classification. Further histopathological confirmation of clinical diagnosis can enhance the diagnosis and treatment modalities.

Characteristic hysteroscopy appearance considerations for detecting uterine endometrial malignancies.

The effectiveness of hysteroscopy in diagnosing endometrial lesions has been demonstrated, showing high diagnostic accuracy for malignant endometrial lesions. Although the characteristic appearances of atypical and malignant endometria have been reported, they are not definitive and sometimes complicated. This study aimed to identify a small number of characteristic features to detect endometrial abnormalities using a simple judgment system and analyze the diagnostic characteristics and their accuracy in endometrial malignancy diagnosis. We performed a retrospective analysis of hysteroscopy video data of 250 patients, of which we selected for analysis based on pathology examination 152 cases with benign changes, 16 with atypical endometrium, and 18 with carcinoma in situ or endometrial cancer. Endometrial characteristics assessed included protrusion, desquamation, extended vessel, atypical vessel, and white/yellow lesion. Multivariable analysis revealed that desquamation (p = 0.001, odds ratio [OR] 5.28), atypical vessels (p < 0.001, OR 8.50), and white/yellow lesions (p = 0.011, OR 1.37) were significant predictors for endometrial malignancy. From their contribution status, scoring points of 4, 6, and 1 were settled according to the odds ratio proportions. When scores ≥5 (at least both desquamation and white/yellow lesions or only atypical vessels) were used to define endometrial malignancy, sensitivity and specificity were 100% and 92%, respectively. When detecting cancer, atypical, and benign cases, sensitivity and specificity were 88% and 90%, respectively. Our characteristics hysteroscopic findings showed a higher predictive ability in detecting endometrial malignancies. However, further examination with more cases would be needed to accurately diagnose endometrial malignancy by hysteroscopy.

Endometrial congestion is the only hysteroscopic finding indicative of chronic endometritis.

Chronic endometritis (CE), an inflammatory condition characterized by plasma cell infiltration within the endometrial stroma, is prevalent among women experiencing unexplained infertility or recurrent miscarriages. CE is traditionally diagnosed by endometrial biopsy using CD138 immunohistochemistry staining. Despite some studies suggesting hysteroscopy as an alternative diagnostic tool, its reliability compared with biopsy remains controversial. This study evaluated the diagnostic accuracy of hysteroscopy for CE by examining endometrial features, such as congestion, micropolyps, edema, and polyps, and comparing these with biopsy-confirmed cases of CE. This retrospective observational study was conducted at Toho University Omori Medical Center between June 2017 and November 2019 and included patients undergoing both hysteroscopy and histopathological examination. Endometrial congestion was identified as the only hysteroscopic finding significantly associated with CE, showing a moderate diagnostic agreement with biopsy results. These findings highlight the importance of further investigating hysteroscopic features of CE and their diagnostic implications and identify endometrial congestion as a potential predictive marker for CE.

Effect of office hysteroscopy on in-vitro fertilization in a fertility centre in Abuja, Nigeria: A prospective study

Background: Fifteen percent of married couples worldwide experience infertility despite unprotected intercourse and approximately 50% of infertile women has uterine pathologies. The success of in vitro fertilization can be assessed using various measures including pregnancy rate, implantation rate and the most acceptable, live birth rate. Various modalities have been employed to investigate endometrial pathologies responsible for infertility.&#x0D; Objectives: To determine and compare the incidence, and pathology in infertile women seen on hysteroscopy and TVS, and the effect on IVF success&#x0D; Methods: This study had 41 participants, 24 had previous Assisted Reproductive Therapy while 17 had not undergone the process. The 41 participants included those that had both TVS and office hysteroscopy. Abnormal findings were recorded and management carried out based on the abnormality detected.&#x0D; Result: Forty-one infertile women aged 26 to 45 years were included in the study. About fifty-eight percent had history of IVF attempts, while 41.46% had no history of IVF. TVS and hysteroscopic examinations were performed on all the patients. TVS findings indicated 26.83% normal findings and 73.17% abnormal pelvic findings. Hysteroscopic findings showed 90.25% patients had abnormal uterine findings&#x0D; Conclusion: This study shows that Hysteroscopy is more sensitive and useful in the diagnosis and treatment of infertility than TVS. Diagnostic measures for hysteroscopic detection of uterine lesions revealed a sensitivity of 78.95% (95% CI 62.68- 90.45), 100% specificity and positive predictive value, with a Negative predictive value of 33.33% (95% CI 21.27 – 48.07) and diagnostic accuracy of 80.95% (95% CI 65.88 – 91.40). These are in keeping with other studies.

#199 : Does Hysteroscopic Evaluation of Uterine Characteristic Improve Outcome of Thin Endometrium in Patients with a History of Repeated Implantation Failures?

Background: Repeated implantation failure (RIF) is a problem for many patients suffering from infertility and their physicians. Despite numerous developments in the field of assisted reproduction, the implantation rate remains low. Among the various reasons of implantation failure, endometrial regularity has an important role. Recently, hysteroscopy is an accurate method for evaluating the endometrial integrity, with the ability to treat uterine pathology for repeated implantation failure patients. Objective: The aim of this study to evaluate the incidence of uterine pathology among infertile women with a history of two implantation failures after IVF and estimate the effect of diagnostic hysteroscopy and hysteroscopic procedures in uterine cavity on achieving a pregnancy in these patients in Mongolia. Materials and Methods: The retrospective study population included infertile women who attended the outpatient department of the Creation and Love Women’s infertility clinic, between August 2020 and July 2022 in Mongolia. The study inclusion criteria were women who had more than two RIF of IVF/ET cycle. Pregnancy and nonpregnancy rate after hysteroscopic procedures were analyzed included in patients reports archived in clinical data. Results: Hysteroscopy were performed on 35 women who had at least two RIFs. The participants’ mean age was 40.3±5.3 and mean duration of infertility year was evaluated 5.53±3.7. Mean AMH level was 1.4±1.6 ng/ml. All patients were diagnosed abnormal uterine cavity by hysteroscopy. Out of 35 patients participated in this study who underwent hysteroscopic evaluation, 20 patients (57.1%) showed synechiae (mild, moderate and severe synechiae). Second most frequent hysteroscopic finding was the endometrial polyp, accounting for 15 (42.9%) patients. Pregnancy rate after hysteroscopic procedures was 8 patients (23%) in this study group. The duration of infertility year was significantly different in pregnant and nonpregnant women underwent hysteroscopic correction (p&lt;0.05). Conclusion: The intrauterine pathology diagnosed by hysteroscopy in patients with previous IVF failure were found all patients in this study. The synechiolysis was common abnormality in Mongolia may cause by artificial abortion. The correction of abnormalities such as and polyp synechiolysis might improve the outcome of successful pregnancy rate.

Hysteropathological Correlation in Abnormal Uterine Bleeding in a Tertiary Care Hospital in South India.

Abnormal uterine bleeding is a common problem mainly encountered in reproductive age group and post-menopausal women. Hysteroscopy is a safe, simple, well tolerated and reliable procedure for the diagnosis of AUB across all age groups. The aim of the study is to determine the association of hysteroscopy and histopathologic examination (HPE) findings in abnormal uterine bleeding. The secondary objective of the study are to enumerate the hysteroscopy findings in patients with AUB and to evaluate the pattern of AUB. Observational cross-sectional study among 60 women in reproductive and post-menopausal age group presenting with features/symptoms suggestive of abnormal uterine bleeding were studied. All patients reporting in the outpatient department (OPD) and who are eligible to participate were included in the study, after obtaining written informed consent. Detailed history, Clinical examination, Ultrasound pelvis and endometrial thickness assessment is done. Hysteroscopic findings were compared against histopathological findings. The various patterns of bleeding documented in our study population were menorrhagia, metrorrhagia, menometrorrhagia, polymenorrhea, and post-menopausal bleeding. Out of these patterns, the commonest was menorrhagia at 50.0% and post-menopausal bleeding at 26.67%. In our study population, the various hysteroscopy findings were strawberry, tongue-shaped projections, pebble stones, polypoidal patterns, and cerebroid patterns. Out of these, the most common was a polypoidal pattern, strawberry pattern, and tongue-shaped projections with 45%, 31.67%, and 26.7%, respectively. The most common histopathology finding was secretory and proliferative constituting 35% and 26.67%, respectively. Carcinoma endometrium constitutes about 6.67% of the study population. The sensitivity, specificity, PPV, and NPV of strawberry appearance in hysteroscopy in comparison with secretory changes in histopathology were 52.38%, 79.49%, 57.89%, and 75.61%, respectively. The sensitivity, specificity, PPV, and NPV of tongue-shaped projections appearance in hysteroscopy in comparison with HPE findings was 60%, 76.36%, 18.75%, and 95.45%, respectively. The sensitivity, specificity, PPV, and NPV of polypoidal pattern in hysteroscopy in comparison with Endometrial hyperplasia in histopathology was 66.67%, 56.14%, 7.41%, and 96.97%, respectively. The sensitivity, specificity, PPV, and NPV of cerebroid appearance in hysteroscopy in comparison with carcinoma endometrium in histopathology were 75.0%, 100%, 100%, and 98.25%, respectively. This correlation of cerebroid pattern with carcinoma endometrium was highly significant. Among all correlations, the highly reliable was in Carcinoma endometrium followed by endometrial polyps. Hysteroscopy has high sensitivity and specificity in diagnosing intrauterine pathology especially endometrial cancer followed by endometrial polyps. Among the various patterns of abnormal uterine bleeding, menorrhagia was the most common. A combination of hysteroscopy and endometrial sampling was found to increase diagnostic accuracy in patients with abnormal uterine bleeding and will effectively guide us in planning the appropriate management for these patients.

Laparoscopic and hysteroscopic findings in women with sub-fertility and tuberculosis: A case series.

Evaluation of hysteroscopic and laparoscopic findings in subfertile women predictive of tuberculosis. Retrospective case series analysis. Tertiary hospital in India. A retrospective analysis of 16 784 subfertile women who had undergone diagnostic hysterolaparoscopy (DHL) was conducted between February 2014 and June 2021. Histopathological evidence, acid-fast bacilli (AFB), culture and GeneXpert MTB/RIF assay were used to diagnose female genital tuberculosis (FGTB). Various hysteroscopic and laparoscopic findings were analysed, and a binary logistic regression assessed associations between these findings and positive diagnostic outcomes. Various hysteroscopic and laparoscopic findings correspond to tubercular manifestation. Of the 16,784 patients, 1083 had hysteroscopy and laparoscopy findings suggestive of tuberculosis, and 309 were diagnosed with FGTB based on diagnostic tests. Logistic regression identified variables strongly predictive of positive status outcomes; tuberculous abdomino-pelvic adhesions of various grades, isthmo-ampullary block, tubercle, tubo-ovarian mass, tuberculous hydrosalpinx, complete tubal destruction, tubal diverticula and rigid tube emerged as strong predictors. Logistic regression-derived predictors, alongside specific laparoscopic and hysteroscopic findings, can enhance diagnostic accuracy and clinical decision-making to start antitubercular therapy in subfertile women.

An analytical study of hysteroscopic evaluation in patients with abnormal uterine bleeding, and its correlation with histopathology

Abnormal uterine bleeding (AUB) refers to bleeding that occurs outside of normal menstrual cycles and includes changes in the regularity, frequency, duration, or amount of bleeding during or between periods. AUB is a condition that causes significant impairment in women's health, impacting a substantial proportion of women in different stages of their reproductive life with 14-25% of women of reproductive age and up to 50% of women in the perimenopausal phase experience the effects of this condition. The present study was analytical observational study conducted in the Department of Obstetrics and Gynaecology for the period of 18 months. Prior to commencement, the study obtained approval from the ethics committee at the hospital, and 63 women aged 35 or above, who were experiencing abnormal uterine bleeding, willingly participated in the study by providing written consent.. Each patient underwent a thorough medical history and general systemic examination. They were also subjected to baseline investigations, transvaginal sonography, diagnostic hysteroscopy, and endometrial biopsy. The overall diagnostic accuracy of our study came out to be 90.48%. The correlation between Histopathological and Hysteroscopic findings of the endometrium and was found to be statistically significant (p&amp;#60;0.05). Hysteroscopy is a valuable diagnostic tool for identifying the underlying cause of AUB. Proper management of AUB will depend on several factors including the patient's age, fertility goals, and the results of the final histopathology. While hysteroscopy is a valuable tool for visualizing abnormalities in the uterine cavity, it is important to note that it is not a substitute for tissue diagnosis, which is considered the gold standard. Rather, hysteroscopy complements other diagnostic procedures by offering the advantage of direct visualization of any abnormalities within the uterine cavity.

Comparing endometrial biopsy results with hysteroscopic pathology in women presenting with abnormal and postmenopausal uterine bleeding

ObjectiveTo compare pathology results after office-based blind endometrial biopsy and pathology results from hysteroscopy in women presenting with abnormal uterine bleeding (AUB). MethodsA retrospective cohort study of biologic women presenting with AUB at a tertiary care referral care center. Patients were included if they underwent evaluation with blind endometrial biopsy performed in the office followed by hysteroscopy within one year. Hysteroscopic findings and pathology were correlated with index endometrial biopsy findings. Results689 patients met inclusion criteria. The mean age and BMI were 49 (±10) years and 31 (±8) kg/m2. The median duration of bleeding leading up to presentation was of 3.5 (1.5–9) months. Of the patients who had operative hysteroscopic pathology demonstrating endometrial polyp, 30.6 % (81) had a polyp detected on office endometrial biopsy. Of the patients who had hysteroscopic pathology demonstrating intracavitary fibroids, 0 % (0) were detected on endometrial biopsy. Of the patients who had hyperplasia without atypia on hysteroscopy, 28.6 % (4) were detected or suspected on endometrial biopsy. Of the patients who had hyperplasia with atypia on hysteroscopy, 5.9 % (1) were detected or suspected on endometrial biopsy. There were 12 cases of confirmed or suspected malignancy on hysteroscopy, of which 8.3 % (1) were detected on endometrial biopsy. ConclusionConcordance between focal findings on office hysteroscopy and endometrial biopsy is low. Endometrial biopsy when malignancy is suspected has been shown to be of benefit, but in the setting of suspected benign focal pathology, blind assessment of the endometrial cavity for definitive diagnosis should be abandoned. In women with symptomatic uterine bleeding, hysteroscopic visualization is associated with increased sensitivity in identifying intrauterine pathology.

Comparison of clinical outcomes and second-look hysteroscopy of the complete and incomplete septate uterus after hysteroscopic septoplasty.

Septate uterus is the most common congenital uterine malformation. This retrospective cohort study compared clinical outcomes and second-look hysteroscopy findings in patients with complete and incomplete septate uteri after septoplasty. We reviewed the medical records of patients with a septate uterus who underwent hysteroscopic septoplasty and second-look hysteroscopy at the West China Second University Hospital between September 2013 and September 2021. Information regarding pregnancy outcomes was collected through telephone interviews. The independent samples t-test, Mann-Whitney U test, Pearson's chi-square test, and Fisher's exact test were used to explore the differences between the complete and incomplete septate uterus groups. A total of 64 patients were enrolled in this study. There was no significant difference in intrauterine adhesion (IUA) rates (16.7% and 32.1%), pregnancy rates (44.1% and 42.9%), term delivery rates (35.3% and 32.1%), premature delivery rates (2.9% and 0), placenta previa rates (2.9% and 3.6%), placenta implantation/adhesion rates (5.9% and 3.6%), and premature rupture of membranes rates (2.9% and 0) between the complete and the incomplete group after hysteroscopic septoplasty (P > 0.05). Endometrial polyps in the septate uterus were common, with an incidence of 33.3% and 25% in the complete and incomplete groups, respectively (P > 0.05). The pregnancy outcomes of complete and incomplete septate uteri after hysteroscopic septoplasty were similar. There was no statistical difference in IUAs after surgery. Different treatment strategies may not be required for complete or incomplete septate uteri.