Hysteroscopic Findings Research Articles

The hysteroscopy and histological diagnosis and treatment value of chronic endometritis in recurrent implantation failure patients

To study the consistency of hysteroscopy findings and histological chronic endometritis (CE) in recurrent implantation failure (RIF) cases, and to compare their values in indicating antibiotic treatment. Sixty RIF cases (January 2009-January 2010) and 202 consecutive RIF cases (May 2010-April 2012) in Peking University Third Hospital reproductive medical center were studied. 60 RIF patients' endometrial samples redid section and CD38/CD138 immunohistochemical stain for CE screening. In 202 RIF cases, the presence of hyperemia, mucosal edema, and micropolyps under hysteroscopy were considered CE diagnostic parameters. Antibiotic was offered to part of the patients. The patients' clinical outcomes were analyzed by statistical methods. In 202 RIF cases, the hysteroscopy CE rate was 66.3 %, while histological CE rate was 43.6 %. The sensitivity and specificity of hysteroscopy were 35.2 and 67.5 %. In histological CE patients, 68 cases underwent regular antibiotic treatment and 20 did not. Two groups had similar clinical pregnancy rates (35.3 vs. 30.0 %), embryo implantation rates (18.9 vs. 20.4 %) and ongoing pregnancy rates (29.4 vs. 25.0 %). In hysteroscopy CE patients, the implantation rate (18.6 vs. 4.9 %) and ongoing pregnancy rate (29.3 vs. 7.4 %) significantly increased (P < 0.05) with antibiotic treatment, and higher intrauterine pregnancy rate in treatment group (29.3 vs. 11.1 %). In reviewing the chosen 60 RIF cases, the histological CE rates were similar in both pregnancy and non-pregnancy group after subsequent embryo transfer. CE occurs frequently in RIF patients; hysteroscopy has more diagnostic and treatment value for them.

Giant endometrial polyp protruding from the external cervical os in a postmenopausal woman: magnetic resonance imaging and hysteroscopic findings

Endometrial polyps are most commonly seen in the postmenopausal women with uterine bleeding, although the giant polyps which originate from the uterine cavity and protruding from the cervical os are rare. Several cases which have been described in the literature are usually developed secondary to tamoxifen use, and the polyps do not extend or protrude from the external cervical os. Most of the polyps protruded from the cervical os can mimic a cervical neoplasia or endocervical polyp. We report the case of a giant endometrial polyp (8x4x3 cm in size) which was protruding from the external cervical os and that developed spontaneously without tamoxifen use in a multiparous 73 -year-old woman presenting with vaginal bleeding. Hysteroscopic polypectomy was performed and no recurrence was seen at 6 months after surgery. Diagnosis, management and outcome of this rare entity have been discussed according to the literature.

Hysteroscopic Findings in Postmenopausal Women with Endometrial Fluid Collection

Hysteroscopic Findings in Postmenopausal Women with Endometrial Fluid Collection

The Diverse Hysteroscopic Appearance in Cases of Retained Products of Conception

Retained products of conception (RPOC), also called residual throphoblastic tissue, may occur after any type of delivery or pregnancy termination. Hysteroscopy is considered the gold standard for the diagnosis of RPOC. From our experience, different types of RPOC have different hysteroscopic appearance. The purpose of this video is to describe the hysteroscopic findings in cases of RPOC and the hysteroscopic approach used to treat these cases.

English

AIM: This study was designed to define diagnostic value of hysteroscopy in perimenopausal abnormal uterine bleeding compared to histopathology study of blind dilatation & curettage. SETTING: The study entitled Value of Hysteroscopy in Perimenopausal Abnormal Uterine Bleeding Compared to Histopathology Study of Blind Dilatation & Curettage was done in M.K.C.G. Medical College & Hospital, Berhampur, Odisha, India. The study period extended from August 2012 to August 2013. METHODS: 100 patients in perimenopausal age group with abnormal uterine bleeding underwent hysteroscopy under short general anaesthesia followed by blind D&C. The findings of hysteroscopy were compared with histopathology study of D&C. RESULTS: In the present series overall Diagnostic accuracy, Sensitivity, Specificity, Positive predictive value, Negative predictive value of hysteroscopy are 90.2%, 85.11%, 98.06%, 90.28%, 94.69% respectively. Sensitivity, Specificity, Positive predictive value, negative predictive value of hysteroscopy for submucous myoma was 100% each. Sensitivity, Specificity, Positive predictive value, Negative predictive value of hysteroscopy for endometrial polyp was 100, 97.61, 88.88, 100% respectively. CONCLUSION: Hysteroscopy is a valuable, simple, low-risk technique which allows an adequate exploration of uterine cavity under visual control. It ensures speed and safety with the diagnosis and treatment. The results are immediately available. It allows finding out the source of bleeding and perform a directed biopsy from the suspected area. Hysteroscopic-guided biopsy and histopathology are considered as the new gold standard in evaluating a case of perimenopausal abnormal uterine bleeding.

Role of Hysteroscopy Prior to Assisted Reproduction Techniques

Study ObjectiveTo determine whether diagnostic hysteroscopy before assisted reproduction techniques (ΑRT) in women without known disease of the uterine cavity is necessary. DesignProspective cohort clinical study. SettingReproductive medicine clinic. PatientsThe study group consisted of 217 infertile women attending the Reproductive Clinic for examination before undergoing ART, either in vitro fertilization or intracytoplasmic sperm injection. InterventionsPatients underwent transvaginal sonography (TVS) and hysterosalpingography (HSG) for initial evaluation. If there were no abnormal intrauterine findings, diagnostic hysteroscopy was additionally performed. Measurements and Main ResultsThe safety and diagnostic value of hysteroscopy before ART was examined. Diagnostic hysteroscopy was performed successfully, without complications, in all 217 women. Ninety-five (43.7%) had a history of ART failures (group 1), and 122 (56.3%) had undergone no previous ART attempts (group 2). In 148 women (68.2%), findings at hysteroscopy were normal, whereas in 69 (31.8%), hysteroscopy revealed intrauterine lesions (polyps, septa, submucosal leiomyomas, or synechiae) that led to operative hysteroscopy. The most common intrauterine abnormality was the presence of endometrial polyps in 26 patients (12%). The total percentage of abnormal intrauterine findings was higher in women with a history of repeated ART failures in comparison with those with no history of ART attempts. No statistically significant difference in the outcome of in vitro fertilization or intracytoplasmic sperm injection was observed between women with normal hysteroscopic findings and patients with hysteroscopically corrected endometrial disease. ConclusionSensitivity of diagnostic hysteroscopy is significantly higher than TVS and HSG in the diagnosis of intrauterine lesions. Diagnostic hysteroscopy should be performed before ART in all patients, including women with normal TVS and/or HSG findings, because a significant percentage of them have undiagnosed uterine disease that may impair the success of fertility treatment.

Hysteroscopic aqua-dissection of fallopian tubes in long standing infertility with pelvic tuberculosis--a retrospective study

To assess the effectiveness of hysteroscopic aqua-dissection of fallopian tubes as a fertility enhancing tool in cases of infertility of long duration with pelvic tuberculosis. A retrospective study of 100 cases of long standing infertility with pelvic tuberculosis and to evaluate the results of controlled hysteroscopic aquadissection. 100 cases of pelvic tuberculosis diagnosed on the basis of abnormal hysteroscopy findings Supported by PCR for mycobacerium / AFB culture / histopathology / quantiferon gold / high ESR / chest x-rays / previous history or family history of tuberculosis. All the cases were of 25 to 35 years of age suffering from infertility of more than 7 years duration and had undergone more than 4 cycles of ovulation induction, had at least one HSG more than a year back. All cases were subjected to controlled hysteroscopic aquadissection of fallopian tubes in two stages and were given course of anti-tubercular medication with minimal four drugs for two months and three drugs for four months and the pregnancy outcome was evaluated in relation to the hysteroscopic aqua-dissection. Out of 100 cases studied between 2007 - 2013, a total of 52 cases became pregnant after the hysteroscopic aquadissection and antitubercular medication in cases of pelvic tuberculosis diagnosed on the basis of grossly abnormal hysteroscopy findings with or without other supportive markers. 43 had term delivery, 5 cases had preterm delivery between 34-35 weeks of gestation and 2 cases had missed abortion and 2 cases had anembryonic pregnancy. Hysteroscopy is an important diagnostic and fertlity enhancing tool and controlled hysterscopic aquadissection of fallopian tube must be considered in cases who can not bear expensive IVF treatment.

Study of Combined Laparoscopic and Hysteroscopic Findings in 100 Cases of Infertility

ABSTRACT Objectives To study the role of combined diagnostic laparoscopy and hysteroscopy in evaluation of female infertility. To find out different factors associated with infertility. To provide concurrent therapeutic management. Materials and methods A total of 100 women underwent combined diagnostic laparoscopy and simultaneous diagnostic hysteroscopy during the period from January 2015 to December 2015 in the Obstetrics and Gynecology Department, Umaid Hospital, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India. Results Age ranged from 21 to 38 years, and mean age was 25.98 years. Abnormal laparoscopic findings were noted in 41% cases, abnormal hysteroscopy seen in 24% cases, and 17% cases showed abnormality in both. Bilateral tubal patency was demonstrated in 81% cases. Tubal blockage was bilateral in 5% and unilateral in 9% cases. In 2% cases, bilateral block with beaded appearance found suggestive of tuberculosis. Of total 100 cases, 12% cases were found to have endometriosis, 8% had polycystic ovarian syndrome (PCOS), chocolate cyst was found in 5% cases, and 7% had functional cyst of ovary. Pelvic adhesions were found in 15% patients. Myomas were found in 8% cases. Endometrial polyps were revealed in 5% and Asherman’s syndrome in 6% patients. Combined laparoscopy and hysteroscopy was diagnostic in 17% of cases, 41% were diagnosed through laparoscopy alone, 24% through hysteroscopy alone, while in 18% cases findings were normal. In our study, tuboperitoneal factors were responsible for infertility in 40% cases, ovarian factors in 26% cases, and PCOS in 8% cases. Conclusion In our study, 74% of the cases had some form of tubo-ovarian pathology, which makes laparoscopy an essential tool of infertility workup. Although hysteroscopy alone was diagnostic in 30% of cases, its simultaneous use with laparoscopy provides cost-effective, comprehensive, and single setup diagnostic aid in these kinds of patients. How to cite this article Jodha BS, Chawla P. Study of Combined Laparoscopic and Hysteroscopic Findings in 100 Cases of Infertility. Int J Gynecol Endsc 2017;1(1):5-10.

Role of hysteroscopy and endometrial biopsy in women with unexplained infertility

This study was designed to evaluate the role of hysteroscopy and endometrial biopsy in women with unexplained infertility. Women with unexplained infertility were included in this prospective study, evaluated with transvaginal sonography and diagnostic hysteroscopy. Diagnostic hysteroscopy was performed between the 7th and 11th day of the cycle. The criteria for hysteroscopic findings were based on the cervical canal, uterine cavity, endometrium, visualization of the ostium tubae and lesions of the utero-tubal junction. After the hysteroscopic examination, endometrial biopsy was performed using a Pipelle endometrial suction curette. Patients were classified according to the hysteroscopy results into four groups: patients with no abnormality detected (14), patients with cervical abnormalities (six), patients with endometrial abnormalities (73) and patients with uterine abnormalities (seven). One hundred women with unexplained infertility were included. All patients underwent diagnostic hysteroscopy, except for seven patients: six patients had stenotic external or internal cervical ostium and one had inadequate visualization as the uterine cavity was filled with blood. Based on hysteroscopic findings, 31 patients were finally diagnosed with endometrial polyps; 14 endometritis; 15 endometrial hyperplasia; six submucous myomas; seven intrauterine synechiae (73 cases = endometrial abnormalities group); seven congenital uterine anomalies (uterine abnormalities group), six cervical stenosis (cervical abnormalities group) and 14 women without any uterine abnormalities (no abnormalities group). Analysis of samples obtained using the Pipelle endometrial suction curette was non-diagnostic in 16 cases; the most common endometrial pathological feature detected by this analysis was endometritis (15%). Routine hysteroscopy and endometrial biopsy should be used as a basic part of the work-up for women with unexplained infertility.

The clinical characteristics of women with recurrent implantation failure

Recurrent implantation failure (RIF) refers to failure to conceive after three or more in vitro fertilisation (IVF) or embryo transfer cycles. Implantation failure may be due to embryo or uterine factors. There are many controversies surrounding the investigation and management of this condition. The aim of our study was to describe the clinical characteristics and the outcome of investigations of a group of women with recurrent implantation failure. A total of 111 couples with RIF were managed in a dedicated clinic and investigated according to a clinic protocol. The frequency of abnormal investigations were as follows: high (≥ 10 IU/l) FSH, 14/107(13%); high free androgen index 6/78(8%); abnormal hysteroscopic findings 7/45(16%); hydrosalpinges 8/33(24%); persistently elevated ACA or tested positive for lupus anticoagulant 19/108 (18%); abnormal karyotype analysis 3/101(3%); hyperprolactinaemia 1/79(1%); abnormal thyroid function 4/100(4%) and tested positive for thyroid peroxidase antibody 10/104(10%). Specific treatments according to the results of investigation produced a live birth rate of 29%. It was concluded that the findings should help practitioners to construct suitable investigation protocols for the initial management of this condition.

DIAGNOSTIC HYSTEROSCOPY IN ABNORMAL UTERINE BLEEDING &amp; IT'S HISTOPATHOLOGIC CORRELATION: OUR EXPERIENCE

Abstract Aims &amp; objectives: 1) To study the accuracy of hysteroscopy in evaluation of abnormal uterine bleeding in perimenopausal and postmenopausal women. 2) To correlate hysteroscopic findings with histopathologic results. Materials and methods: It is a retrospective study done in the department of OBG at K. S.Hegde Medical Academy, Mangalore. All patients who underwent diagnostic hysteroscopy for abnormal uterine bleeding in the past 6 years were included in this study. Patients underwent clinical and sonographical evaluation. Following hysteroscopic evaluation, patients had undergone dilatation and curettage and endometrial curetting were sent for histopathological examination (HPE). The correlation between findings on hysteroscopy &amp; HPE were tabulated. Results: On hysteroscopy, endometrium was classified as suggestive of normal, hyperplasia, atrophic, polyp, fibroid, cancer. Histopathological diagnosis was taken as gold standard to determine the efficacy of hysteroscopy in diagnosing endometrial pathologies. Out of 175 patients, 108 patients were diagnosed to have endometrial hyperplasia on hysteroscopy, however only 53 confirmed to have on histopathologically. Similarly 25 patients were said to have normal findings on hysteroscopy but by histopathology 85 were having normal endometrium. Hysteroscopy was highly specific for diagnosis of polyp (95.9%), cancer (100.0%), and atrophy (96. 9%), normal endometrium (92.2%) but low specificity for diagnosing hyperplasia (48.4%). The sensitivity of hysteroscopy in diagnosing polyp and endometrial hyperplasia were 100% and 84.9% respectively but it was low in case of cancer (16.7%) and normal endometrium (21.2%). Conclusion: Hysteroscopy is a highly accurate diagnostic tool in diagnosing intrauterine lesions like endometrial polyp and submucous fibroid. In fact, it was also found to be highly specific in conditions like endometrial cancer, polyp, atrophic and normal endometrium.

Hysteroscopic findings in infertile women: A retrospective study

Abstract Background Lower pregnancy rates are observed in patients with uterine cavity anomalies. The correction of these anomalies has been associated with improved pregnancy rates. Diagnostic hysteroscopy can be performed in an office with minimal discomfort and superior sensitivity and specificity in evaluation of the uterine cavity. Our study was done to evaluate the importance of office hysteroscopy (OH) in diagnosis of pathology among infertile women. Objective To study incidence of abnormal hysteroscopic findings among infertile women. Materials and Methods We retrospectively studied 432 office hysteroscopies in patients referred to our unit because of their infertility problem. Two hundred and seventy-four patients (63.43%) were with primary infertility and 158 (36.57%) were with secondary infertility. Results Normal hysteroscopic findings were reported in 344 women (79.63%). The other 88 (20.37%) were with abnormal hysteroscopy. The most common reported hysteroscopic abnormality was intrauterine adhesions (IUA) 31.81% (28/88) followed by endometrial polyp 26.13% (23/88). Pre-hysteroscopic uterine investigations (ultrasound or hysterography) were available, only, in 207 women. In 143 patients with normal pre-hysteroscopic uterine investigations, office hysteroscopy revealed uterine cavity abnormalities in 21 women (14.68%). Of those with abnormal pre-hysteroscopic findings, 64 patients, hysteroscopy examinations were normal in 16 patients (25%). Conclusions Office hysteroscopy should be a part of routine work up in infertile patients as routine uterine investigatory methods (ultrasonography and hysterography) have only sensitivity and specificity value of 67.19% and 85.31% respectively.

Endometrial surveillance in tamoxifen users: role, timing and accuracy of hysteroscopic investigation: observational longitudinal cohort study

To determine the role, timing and indications for endometrial hysteroscopic investigation in relation to the clinical, ultrasound and histological features of the endometrium during tamoxifen (TAM) use. We performed an observational longitudinal cohort study (years 2007-2012) that investigated the endometria of 151 TAM users with hysteroscopy and histology. For all patients, gynaecological history, years of adjuvant treatment, ultrasound endometrial thickness measurement and indications for hysteroscopy were recorded. Hysteroscopic findings showed that 100% of patients referred for simple follow-up had no evidence of endometrial disease. We found a strong correlation between previous history of abnormal uterine bleeding (with or without endometrial thickening) and hysteroscopic suspicion of endometrial atypia that was confirmed by histology. Hysteroscopy had 83.3% sensitivity, 99% specificity, 83.3% positive predictive value (PPV) and 99% negative predictive value (NPV) in detecting endometrial atypia. No significant correlation was found between endometrial thickening to >5 mm without bleeding and histological atypia. Similarly, the duration of treatment was not related to endometrial thickening and histological atypia. Endometrial stromal hyperplasia was detected by histology in 70.5% of patients with endometrial thickness measurements ranging from 5 to 10 mm. In contrast, no atypia was detected when endometrial thickness was <5 mm. Ultrasound performed using a 5-mm cut-off threshold for endometrial thickness resulted in 100% sensitivity, 15% specificity, 4% PPV and 100% NPV in detecting endometrial atypia, while a 10-mm cut-off threshold resulted in 84% sensitivity, 69% specificity, 10% PPV and 99% NPV. Low-risk TAM users do not require different endometrial surveillance than the general population. Hysteroscopy could play a fundamental role in determining the endometrial status of patients before the initiation of TAM treatment and in assessing the endometrial status of patients when bleeding occurs.

Five Years’ Experience on Hysteroscopy in Abnormal Vaginal Bleeding

Background: Hysteroscopy is the gold standard method for diagnosis of intrauterine pathologies. Current study is a review of hysteroscopic findings performed over a period of 5 years in patients with abnormal uterine bleeding (AUB). Objective: The aim of this study was a review of hysteroscopic findings performed over a period of 5 years in patients with abnormal uterine bleeding (AUB). Patients and Materials: This descriptive analytic study was conducted prospectively on patients in reproductive, premenopausal or postmenopausal ages referring to our hospital with complaint of AUB. All patients underwent hysteroscopy (either diagnostic or therapeutic) by the same surgeons. Analysis was performed on the base of the hysteroscopic findings. Results: In our population study (379 patients) major menstrual pattern was menometrorrhagia. The most common diagnoses at operative hysteroscopy were endometrial polyps (17.8%), hyperplastic endometrium (15.2%), and uterine submucosal myoma (9.7%).The most common findings in patients with menometrorrhagia were myoma, and polyp where, the most common finding in patients with menorrhagia, and metrorrhagia was polyp. Our major complications were uterine perforation in 9, thermal injury in 3, and air emboli in one case. Conclusions: In current study the most common pathology was found to be endometrial polyp. Myoma was the most common finding in patients with menometrorrhagic bleeding. Our major complications were uterine perforation, thermal injury, and air emboli.

Diagnosis of Intracavitary Uterine Diseases in Postmenopausal Women by Hysteroscopy

Objective: To reveal the hysteroscopic findings among postmenopausal women who were subjected to diagnostic hysteroscopy method. Methods: This is a descriptive study which was conducted at King Hussein Medical Center within the period from January 2008 to Janunary 2010, on a total of 215 postmenopausal women. Mean age of the study group was 58 years (range 46-70). Hysteroscopy was carried out to detect intracavitary disease, either by hysteroscopic view or using histopathological biopsies for other diseases. Simple descriptive statistics (frequency, mean age and percentage) were used to describe the study variables. Results: The histopathological and hysteroscopic findings were as follows: polyps in 122 (56.7%) patients, atrophic endometrium in 44 (20.5%) patients, synechia in 22 (10.2%) patients, fibroid in 13 (4.6%) patients, endometrial hyperplasia in seven (3.3%) patients, focal thickening seven (3.3%) patients. Conclusions: The most frequent findings at hysteroscopy for postmenopausal women with bleeding were benign lesions. Hysteroscopy using biopsy is a selective method for detecting intracavitary uterine disease.

Hysteroscopic Findings in Women With Menorrhagia

Study ObjectiveTo describe the hysteroscopic findings in patients complaining of menorrhagia to establish any significant association between menorrhagia and benign/malignant intrauterine disorders. DesignProspective cohort study (Canadian Task Force classification II). SettingUniversity La Sapienza, Rome, Italy. PatientsOne hundred eighteen premenopausal women undergoing office hysteroscopy for menorrhagia (group A) and 344 premenopausal patients undergoing office hysteroscopy for other indications (noncyclic abnormal uterine bleeding, infertility, ultrasonographic abnormalities, etc) (group B). InterventionsOffice hysteroscopy. Measurement and Main ResultsData on the prevalence of hysteroscopic findings (cervical polyps, endometrial polyps, submucous myomas, low-grade hyperplasia and high-grade hyperplasia/endometrial carcinoma) were compared between group A and group B. The total prevalence, as well as the prevalence of type 0 and type I myomas (totally or >50% intracavitary, respectively), and the mean number per patients with submucous myomas was significantly higher in group A compared with group B (p = .0001, p = .024, and p = .017, respectively). Multivariable logistic regression analysis showed a statistically significant association between age (odds ratio 4.15, 95% confidence interval 1.55–11.1 in the 40- to 49-year age group), presence of submucous myomas (odds ratio 2.76, 95% confidence interval 1.52–5.00), and menorrhagia. ConclusionsMenorrhagia seems to be associated with aging, the presence and number of submucous myomas, and with the degree of their intracavitary development.

Hysteroscopic Findings in an Unusual Case of Adenomyosis

Hysteroscopic Findings in an Unusual Case of Adenomyosis

Hysteroscopic Findings in an Unusual Case of Adenomyosis

Adenomyosis is the presence of ectopic endometrial glands and stroma in the myometrium. It traditionally presents with pelvic pain, menorrhagia and dysmenorrhea in the fourth or fifth decade of life. Here, we present a case of adenomyosis presenting with severe menorrhagia at the age of 23 years. Traditionally, adenomyosis is diagnosed in histopathologically, in hysterectomy specimens or myometrial biopsies. Noninvasive modalities, such as transvaginal ultrasound and magnetic resonance imaging aid in diagnosis in the office before treatment is undertaken. Office hysteroscopy is an established tool in the diagnosis of abnormal uterine bleeding and infertility.While hysteroscopy does not have pathognomonic features of adenomyosis, certain patterns have been described in association with adenomyosis, including endometrial defects, abnormal vascularization and cystic hemorrhagic lesions. In this case of adenomyosis, typical appearance of circumscribed endometrial defects on hysteroscopy was seen. This appearance has been described in literature but is the first report from India. Hysteroscopy has the potential to be an important additional procedure for the evaluation of uterine pathology, even in the case of adenomyosis, because it offers the main advantage of direct visualization of the uterine cavity and the possibility of obtaining histological specimens under visual control. With shifting focus toward conservative and fertility preserving management of adenomyosis, office hysteroscopy is likely to emerge as an important tool in the diagnostic armamentarium for adenomyosis.

Role of diagnostic hystero-laparoscopy in the evaluation of infertility: A retrospective study of 300 patients

OBJECTIVE:To determine the role of diagnostic hysterolaparoscopy in the evaluation of infertility in tertiary care centres.MATERIALS AND METHODS:This retrospective study was conducted at two tertiary care centres (the infertility clinics of Sriram Chandra Bhanj Medical College and Prachi hospital at Cuttack, Odisha) throughout the year in 2008. Women aged 20-40 years with normal hormone profile without male factor infertility were included.RESULTS:Out of 300 cases, 206 (69%) patients had primary infertility. While laparoscopy detected abnormalities in 34% of the cases, significant hysteroscopy findings were noted in 18% of cases. Together, diagnostic hysterolaparoscopy detected abnormalities in 26% of the infertile patients in both groups. While the most common laparoscopic abnormality was endometriosis (14%) and adnexal adhesion (12%) in primary and secondary infertile patients, respectively, hysteroscopy found intrauterine septum as the most common abnormality in both groups.CONCLUSIONS:Hysterolaparoscopy is an effective diagnostic tool for evaluation of certain significant and correctable tubo-peritoneal and intrauterine pathologies like peritoneal endometriosis, adnexal adhesions, and subseptate uterus, which are usually missed by other imaging modalities.

Comparison between the Findings of Transvaginal Ultrasonography and Hysteroscopy for the Diagnosis of Endometrial Polyps in Infertile Women

Objective: We examined infertility cases with endometrial polyps. Design: Retrospective study. Setting: Infertility clinic.Patients: Fifty-eight infertile women undergoing transvaginal ultrasonography and hysteroscopyIntervention: Transvaginal ultrasonography and hysteroscopyMain outcome measures: The size and location of endometrial polypResults: We compared the patient group in which the results of transvaginal ultrasonography and hysteroscopy corresponded (Corresponding Group) and the patient group in which the results did not correspond (Non-Corresponding Group). The average size of endometrial polyps in the non-corresponding group (7.8 ± 2.8 mm) was significantly less than those in the corresponding group (12.4 ± 5.1 mm). In the Corresponding Group, 90% of the endometrial polyps were detected within the upper two-third of the uterine cavity (fundal side), and 10% of the endometrial polyps were detected in the lower one-third of the uterine cavity (cervical side). In the Non-Corresponding Group, 44% of the endometrial polyps were detected within the upper two-thirds of the uterine cavity (fundal side), and 56% of the endometrial polyps were detected in the lower one-third of the uterine cavity (cervical side).Conclusions: Endometrial polyps that are not detected by transvaginal ultrasonography can be identified by hysteroscopy. Because the polyp size was small in the Non-Corresponding Group and more than 50% of the endometrial polyps are located in the lower portion (cervical side) of the uterine cavity, the endometrial polyps in the Non-Corresponding Group may not be a cause of infertility.