Hysteroscopy In Women Research Articles

Office hysteroscopy for postmenopausal women: Feasibility and correlation with transvaginal ultrasound

ObjectiveTo evaluate feasibility of office hysteroscopy in postmenopausal women and correlation between transvaginal ultrasound (TV-US) and hysteroscopy. MethodsPostmenopausal women addressed at office hysteroscopy for postmenopausal bleeding or increase endometrial thickness were included. A 3.5-mm rigid hysteroscope was used without cervical dilatation or local anaesthesia. Speculum was never used. Data concerning women's symptoms and TV-US findings were collected. ResultsFour-hundred-seventy postmenopausal women referred for office hysteroscopy were included in this descriptive study. Three-hundred-fifty women (74.5%) experienced abnormal uterine bleeding. The success rate of office hysteroscopy was 76.4% and was significantly higher in cases of postmenopausal bleeding (80.9%) than in women without postmenopausal bleeding (63.3%) (p=0.01).Three-hundred-sixteen women had both a successful hysteroscopy and TV-US. The correlation between hysteroscopy and TV-US was 68.5% for the diagnosis of increased endometrial thickness, polyps and submucosal myoma (Kappa=0.28). The rate of endometrial cancer for women with postmenopausal bleeding was 12.6% (n=44) while it was 1.7% (n=2) for asymptomatic women.Two (4.3%) out of these 46 women with endometrial cancer had normal hysteroscopy, while 7 (15.2%) had a normal TV-US (including endometrial thickness below 5mm).Among the 54 women without bleeding and with a thickened endometrium, one (1.8%) had endometrial cancer. ConclusionOffice hysteroscopy is successful without anaesthesia for 76.4% of postmenopausal women. The correlation between TV-US and hysteroscopy is low, and we recommend to practice both sonography and hysteroscopy in women with postmenopausal bleeding.

Hysteroscopic Detection of Intrauterine Pathology in Women with Unexplained Infertility

AbstractBackground: Abnormalities of the uterus are relatively uncommon cause of infertility but should be considered, if no other reason, they can adversely affect the outcome of pregnancies achieved by successful treatment. The anatomic uterine abnormalities that may adversely affect fertility include congenital malformations, leiomyoma's, intrauterine adhesions, and endometrial polyps, but their reproductive implications are most unclear. One of the basic steps of an infertility workup is to evaluate the shape and regularity of the uterine cavity. Acquired uterine lesions, such as uterine fibroids, endometrial polyps, intrauterine adhesions, or all of these, may cause infertility by interfering with proper embryo implantation and growth. Congenital uterine malformations are also thought to play a role in delaying natural conceptionAim of Study: This study was designed to evaluate the role of hysteroscopy in women with unexplained infertility.Patients and Methods: Women with unexplained infertility were included in this cross sectional study, evaluated with transvaginal sonography and diagnostic hysteroscopy. Diag-nostic 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 tubal ostium and lesions of the utero-tubal junction. Patients were classified according to the hysteroscopy results into two groups: Patients with no abnormality detected (n=49), patients with uterine abnormalities (n=71).Results: One hundred twenty women with unexplained infertility were included, all patients underwent diagnostic hysteroscopy. Based on hysteroscopic findings, 22 of them (18.3%) were finally diagnosed to have polyps, 6 patients had cervical stenosis (5%), 1 patients have myomas (.8%), 8 patients had intrauterine synechia (7%) and 19 patients had congenital uterine anomalies (16%). Cervicitis was found in 12 cases (10%), while 3 cases had endocervical cysts (2.5%), cornu not accessible in 4 cases (3.3%), while ostia not seen in 8 cases (6.6%), 3 cases had tight isthmus (2.5%) and 3 cases had polypidal thickness at isthmus (2.5%) while hyster-oscopy results were found to have no abnormality in 49 patients (40.8%).Conclusions: Routine hysteroscopy should be used as a basic part of the work-up for women with unexplained infer-tility.

A Study of the Role of Hysteroscopy in Abnormal Uterine Bleeding

Abstract Objectives: There were two study objectives: (1) to determine the diagnostic accuracy of hysteroscopy in women with abnormal uterine bleeding (AUB) and (2) to correlate hysteroscopic and h...

Expectant management may reduce overtreatment in women affected by unexplained infertility confirmed by diagnostic laparoscopy.

To determine whether the mini-invasive surgery still play a role in the diagnostic workup and in the management of the couples affected by unexplained infertility. 170 infertile women (age range 25-38years) with documented normal ovarian, tubal and uterine function underwent combined hysteroscopic and laparoscopic surgery; 100 women refused surgery or ART treatment (control group) choosing expectant management. A retrospective assessment questionnaire was proposed to enrolled women to collect the rate of spontaneous or ART-induced pregnancies. The combined surgery revealed pelvic pathologies in 49.4% of patients, confirming the diagnosis of unexplained infertility only in 86 of studied patients. In this group of 86 selected women, 28 of them achieved a spontaneous pregnancy and 23 women obtained pregnancy after ART. The Chi-square analysis shows that the pregnancy rate was not influenced by the employment of ART. In the group of 100 control women, only 14 (14%) achieved a spontaneous pregnancy after 18months of expectant management. Combined laparoscopy and hysteroscopy in women with unexplained infertility may reveal previously undiagnosed pathologies that could require ART, and in those without abnormal surgical finding, ART does not improve pregnancy rate.

Échecs répétés de fécondation in vitro : anomalies retrouvées sur le bilan diagnostique

ObjectivesInvestigate the proportion of abnormalities identified on the diagnostic assessment performed after at least two previous failed IVF attempts. Discuss the real benefit of this evaluation. MethodsRetrospective descriptive study. Between January 2008 and January 2012, 205 couples with at least two consecutive failed IVF attempts had a diagnosis evaluation which consisted in couple's karyotypes; autoimmune and haemostasis biological check-up, pelvic ultrasound-Doppler and hysteroscopy for women. ResultsThe main biological anomalies were autoimmune for 23.9% of women: antinuclear antibodies (5.7%), antithyroid peroxidase (11.5%) and antithyroglobulin (8.3%); thrombotic with antiphospholipid antibodies for 8.2% of women (1.4% lupus anticoagulant and 6.8% anticardiolipin antibodies), and heterozygous prothrombin gene mutation for 9.5%. Karyotypes were abnormal for 2.1% of women and 0% of men. Ultrasound-Doppler appeared to be abnormal in 44.7% of cases (pulsatility index of uterine artery≥3 and/or protodiastolic notch), and diagnostic hysteroscopy was abnormal in 14.6% of cases. In order to target the real implantation failure, we compared the groups “<8 embryos transferred” versus “≥8 embryos transferred” and “pregnancy after the third or fourth IVF cycle” versus “no pregnancy”, but no statistically significant difference was found. ConclusionThe diagnostic assessment carried out for recurrent IVF failure can detect biological, karyotypic and morphological abnormalities, in the same proportion that in previous studies. Further studies will have to be conducted to evaluate the real impact of these abnormalities in the recurrent implantation failure and the effectiveness of therapeutic care.

Preoperative ripening of the cervix before operative hysteroscopy.

Preoperative ripening of the cervix before operative hysteroscopy.

Does Probability Guided Hysteroscopy Reduce Costs in Women Investigated for Postmenopausal Bleeding?

Objective. To evaluate whether a model to predict a failed endometrial biopsy in women with postmenopausal bleeding (PMB) and a thickened endometrium can reduce costs without compromising diagnostic accuracy. Design, Setting, and Population. Model based cost-minimization analysis. Methods. A decision analytic model was designed to compare two diagnostic strategies for women with PMB: (I) attempting office endometrial biopsy and performing outpatient hysteroscopy after failed biopsy and (II) predicted probability of a failed endometrial biopsy based on patient characteristics to guide the decision for endometrial biopsy or immediate hysteroscopy. Robustness of assumptions regarding costs was evaluated in sensitivity analyses. Main Outcome Measures. Costs for the different strategies. Results. At different cut-offs for the predicted probability of failure of an endometrial biopsy, strategy I was generally less expensive than strategy II. The costs for strategy I were always € 460; the costs for strategy II varied between € 457 and € 475. At a 65% cut-off, a possible saving of € 3 per woman could be achieved. Conclusions. Individualizing the decision to perform an endometrial biopsy or immediate hysteroscopy in women presenting with postmenopausal bleeding based on patient characteristics does not increase the efficiency of the diagnostic work-up.

Prophylactic Antibiotic Treatment during Hysteroscopy: A Systematic Review

Background: Overall, the use of antibiotics is increasing. We noticed different practices amongst different hospitals in their prophylactic use of antibiotics during operative hysteroscopy. This re- view investigates whether there is sufficient evidence to recommend in op- erative hysteroscopy. Methods: We performed a systematic search in Pubmed using hystero- scopy and antibiotic and prophylaxis as search items. We found 16 hits of which 4 were suit- able to include in our review. Findings: In an included Cochrane review no conclusion was drawn since no articles could be included. A prospective study by Nappi et al. (1) support the recommen- dation of the American College of Obstetricians and Gynaecologists not to prescribe routinely an- tibiotic in cases of hysteroscopic surgery. Bhattacharya et al. conducted a prospective study that was ended prematurely. They conclude that there is no convincing evidence that pro- phylactic antibiotics are of value in hysteroscopy. A review by Morrill et al. yielded no new data. Conclusion: We did not find a significant increase in clinical relevant infectious symptoms after hysteroscopy in women treated with or without prophylaxis, although data are insuffi- cient to draw a definite conclusion. Therefore, we suggest a prospective study is mandatory on this topic.

Hysteroscopy in women with abnormal uterine bleeding: a meta-analysis on four major endometrial pathologies.

To determine the accuracy of hysteroscopy in diagnosing endometrial cancer, hyperplasia, polyps and submucous myomas. Relevant articles were retrieved from the MEDLINE and the Cochrane Library (1986-2011). Studies were selected blindly. Results for diagnostic accuracy were extracted to form separate 2 × 2 tables (for endometrial cancer, hyperplasia, polyps and submucous myomas). A summary sensitivity and specificity point reflected the average accuracy observed. Summary ROCs (SROCs) were also calculated according to the HSROC model. For endometrial cancer, the estimated sensitivity was 82.6% (95% CR 66.9-91.8%) and the specificity was 99.7% (95% CR 98.1-99.9%). For endometrial hyperplasia, sensitivity was 75.2% (95% CR 55.4-88.1 %), while specificity was 91.5% (95% CR 85.7-95.0%). For endometrial polyps, sensitivity was 95.4% (95% CR 87.4-98.4%) and specificity was 96.4% (95% CR 93.7-98.0%). Finally, for submucous myomas, sensitivity was estimated to 97.0% (95% CR 89.8-99.2%) and specificity to 98.9% (95% CR 93.3-99.8%). Diagnostic accuracy for hysteroscopy is high for endometrial cancer, polyps and submucous myomas, but only moderate for endometrial hyperplasia.

The application value of hysteroscopy in women with endometrial polyp or uterine malformations seeking for infertility treatment

To explore the application value of hysteroscopy in women with endometrial polyp (EP) or uterine malformations (uterus unicornis, uterus bicornis, or uterus duplex)undergoing intrauterine insemination (IUI) or in vitro fertilzation and embryo transfer (IVF-ET) treatment.

Evaluation of the uterine cavity by magnetic resonance imaging, three dimensional hysterosonography and diagnostic hysteroscopy in women with pre- and post-menopausal bleeding

Abstract Objective To compare the diagnostic potential of magnetic resonance imaging (MRI), three dimensional (3D) hysterosonography and diagnostic hysteroscopy in evaluation of the uterine cavity in women with premenopausal and postmenopausal bleeding. Design Comparative study. Setting Zagazig University hospital. Materials and methods 30 patients with premenopausal bleeding and 30 patients with postmenopausal bleeding scheduled for hysterectomy were submitted to MRI, 3D hysterosonography and hysteroscopy to evaluate the endometrial cavity. Results were compared with histopathologic examination at hysterectomy (the gold standard). Results In the premenopausal group; the sensitivity of MRI was 71.43%, 3D hysterosonography 85.71% and hysteroscopy 80.95%, the specificity of MRI was 55.56%, 3D hysterosonography 66.67% and hysteroscopy 88.89% and the degree of agreement with histopathology was 0.47 for MRI, 0.65 for 3D hysterosonography and 0.73 for hysteroscopy ( P = .000, 0.000 and 0.000, respectively). In the postmenopausal group; the sensitivity of MRI was 88.24%, 3D hysterosonography 88.24% and hysteroscopy 88.24%, the specificity of MRI was 69.23%, 3D hysterosonography 84.61% and hysteroscopy 84.61% and the degree of agreement with histopathology was 0.60 for MRI, 0.72 for 3D hysterosonography and 0.73 for hysteroscopy ( P = .000, 0.000 and 0.000, respectively) and for both groups; the sensitivity of MRI was 78.75%, 3D hysterosonography 86.84% and hysteroscopy 84.21%, the specificity of MRI was 63.64%, 3D hysterosonography 77.27% and hysteroscopy 86.36% and the degree of agreement with histopathology was 0.54 for MRI, 0.69 for 3D hysterosonography and 0.73 for hysteroscopy ( P = .000, 0.000 and 0.000, respectively). Conclusions Hysteroscopy is the best method in evaluation of uterine cavity in women with premenopausal and post menopausal bleeding; but more invasive. MRI is the best method for detection of submucous myoma especially when the cavity is large or tumor is small.

Hysteroscopy in patients with repeated implantation failure improves the outcome of assisted reproductive technology in fresh and frozen cycles

Repeated implantation failure (RIF) is still a problem for many patients and their physicians. Some interventions have been practiced to overcome the problem; one is uterine cavity assessment before assisted reproductive technology (ART) cycles. This study aimed to evaluate the effect of hysteroscopy in women experiencing recurrent implantation failure with apparently normal uterine cavity before assisted reproductive techniques. This was a cohort study with historical controls conducted in a university hospital. A total of 353 women with RIF undergoing ART with normal hysterosalpingography and transvaginal ultrasound were evaluated. The intervention group underwent hysteroscopy with a rigid, 30°, 4-mm hysteroscope in the menstrual cycle just before ART; in the control group hysteroscopy was not performed. Basal characteristics, stimulation parameters and pregnancy rates were compared between the two groups. Chemical pregnancy occurred in 58.5% of women in the hysteroscopy group versus 34.1% of control women (odds ratio [OR]: 2.7; 95% confidence interval [CI]: 1.7-4.2; P < 0.001). Clinical pregnancy occurred in 50.7% and 30.3% of women in the hysteroscopy and control groups, respectively (OR: 2.4; 95%CI: 1.5-3.7; P < 0.001). Delivery rate was 35.5% in hysteroscopy women and 21.1% in control women (OR: 1.9; 95%CI: 1.2-3.1; P = 0.008). The results of hysteroscopy were normal in 103 women (72.5%), and they revealed inflammation in 22 (15.5%), polyp in 16 (11.3%) and Asherman syndrome in one patient (0.7%). Hysteroscopy in the menstrual cycle before ovarian stimulation in fresh cycles and before endometrial preparation in frozen thawed cycles in women experiencing recurrent implantation failure with apparently normal uterine cavity significantly increases the pregnancy rates in fresh and frozen cycles, respectively.

Is hysteroscopy of value for women with previous IVF failure

Objective The aim of this study was to evaluate the value of hysteroscopy in women with a history of previous IVF failures. Design The study was a randomized controlled trial. Participants and methods In all, 100 women with previous IVF failure were randomized into group I (n=50) without hysteroscopic evaluation before ovarian stimulation for intracytoplasmic sperm injection treatment and group II (n=50) who had hysteroscopy. All underwent a repeated IVF cycle. Results Of the 50 patients of infertility with a history of previous failed intracytoplasmic sperm injection undergoing hysteroscopy, 32 (64%) showed normal findings and 18 (36%) showed abnormal findings. A significant difference was found in the clinical pregnancy rates between patients in both groups (P<0.05). Conclusion Hysteroscopy should be performed in every woman with previous IVF failure.

Three-dimensional sonohysterography may replace hysteroscopy for women with perimenopausal bleeding

Objective To investigate whether three-dimensional saline-infusion transvaginal sonohysterography can replace hysteroscopy in the detection of intrauterine lesions in women with perimenopausal bleeding.Materials and methods This study was carried out at the Department of Obstetrics and Gynecology, Menofyia University Hospital in Egypt. Fifty women who presented with perimenopausal bleeding and fulfilled the inclusion criteria were recruited for the study. Three-dimensional sonohysterography was performed followed by hysteroscopy for all women. Results were tabulated and statistically analyzed. The accuracy of both techniques was calculated in terms of sensitivity, specificity, positive and negative predictive values.Results The mean age of women enrolled was 47.5 ± 5.61 years and the mean body mass index was 28.13 ± 2.91 kg/m2. Three-dimensional sonohysterography detected no abnormality in 26 women but hysteroscopy only detected 24 with no abnormality. Compared to hysteroscopy, three-dimensional sonohysterography has sensitivities of 100% and 92% in the detection of endometrial polyps and submucous fibroids, respectively. The specificity of sonohysterography for both lesions was 100%. The sensitivity and specificity for other lesions exceeded 95%.Conclusions Three-dimensional sonohysterosonography may be considered as an effective alternative to hysteroscopy in the assessment of the uterine cavity for any woman with perimenopausal bleeding.

A randomized controlled trial for cervical priming using vaginal misoprostol prior to hysteroscopy in women who have only undergone cesarean section

To evaluate the efficacy of misoprostol administrated vaginally on cervical priming and its complications prior to diagnostic or operative hysteroscopy in women who have undergone at least one cesarean section and who have never delivered vaginally before and/or had other transcervical procedure. A total of 55 patients undergoing hysteroscopy for various intra-uterine lesions were included in this study and were randomly allocated to two groups finally. Thirty patients in the study group were given 200 μg misoprostol vaginally 12 h before the procedure, whereas 25 patients in the control group did not receive any cervical priming. The countered outcome included the cervical width detected with Hegar dilatators and complication rates. Mean cervical width was greater in the study group (6.6 ± 1.3) than in the control group (5.1 ± 0.9). Complications and failure rates were lower in the study group. Application of 200 μg misoprostol vaginally 12 h before hysteroscopy softens the cervix, reduces cervical resistance and consequently the need for cervical dilatation, with only mild side effects.

The risk of diagnostic hysteroscopy in women with endometrial cancer

We sought to evaluate whether hysteroscopy in patients with endometrial cancer had an effect on disease stage or mortality. This was a retrospective cohort analysis of data linked between a registry of women diagnosed with endometrial cancer and physician billing data on hysteroscopy. A 99.8% match rate was obtained. Eighty-five percent of cases had complete data on staging. Of these 1972 cases, 672 (34.1%) had undergone hysteroscopy. There was no difference in stage III disease between the hysteroscopy (7.1%) vs no hysteroscopy (6.5%) group (P = .38). There was also no difference in death rates, 13.2% vs 15.2% (P = .25), or in the proportion of women dying of female genital organ cancer, 46.1% vs 42.1% (P = .53), respectively. Hysteroscopy is not associated with a higher rate of stage III disease or mortality. It allows for accurate diagnosis with direct visualization and biopsy, and should be considered a safe diagnostic tool.

Diagnostic Features and Therapeutic Consequences of Hysteroscopy in Women with Abnormal Uterine Bleeding and Abortion

Problem statement: Hysteroscopy is a procedure in which the endometri al cavity is observable and subject of manipulation via transcer vical route. Hysteroscopy is a minimally invasive process in diagnosis and treatment of many intraute rine and endocervical conditions. Polypectomy, myomectomy and endometrial ablation could be easily manageable by this procedure. According to safety and high efficiency of hysteroscopy, this me thod is changing to a widespread procedure in dealing with many gynecologic and obstetrical condi tions. This study aimed at evaluating the diagnostic and therapeutical efficiency of hysteros copy in managing of common conditions including abnormal uterine bleeding and abortion. Approach: In a descriptive cross-sectional setting, 243 women underwent hysteroscopy were evaluated in two groups: with uterine bleeding 236 cases and with recurrent abortions 7 cases. This study was co nducted in Tabriz Alzahra Educational Center during a 15-month period. The main causes of the complaints were determined in each group. Six months after treatment, the overall success rate was recorded. Results: Hysteroscopy was the sole diagnostic procedure in 16.5 and 14.3% of the patients in grou ps with abnormal uterine bleeding and abortion, respectively. In the group with abnormal uterine bl eeding, curettage, myomectomy, polypectomy, hysterectomy, laparoscopy and laparotomy were the main diagnostic-therapeutical approaches along with the hysteroscopy in descending order. In the g roup with recurrent abortion, laparoscopy, curettag e and myomectomy were the main diagnostic-therapeutical approaches along with the hysteroscopy in descending. There was not any major complication. The diagnostic-therapeutical measures accompanying with the laparoscopy were successful in 73.5% of the bleeding group in follow-up period. Conclusion: Based on our results, hysteroscopy is a safe, accu rate and highly-efficient procedure in managing women with abnormal uterine bleeding and recurrent abortion.

Clinical Analysis of 16 Cases with Duplex Uterus

Objective To explore the diagnosis and treatment of duplex uterus. Methods Totally 16 cases with duplex uterus were diagnosed and treated with hysteroscopy and laparoscopic technology simultaneously. Results Sixteen cases were finally diagnosed with hysteroscopy and B-ultrasound examination. Of the 16 cases, 12 cases underwent vaginal septum resection and hysteroscopic transcervical resection of septum (TCRS), 2 cases underwent lysis of pelvic adhesions, vaginal septum resection and hysteroscopic transcervical resection of septum, and 2 unmarried cases underwent hysteroscopy in women with intact-hymen. All the 16 cases underwent the surgery successfully. Conclusion Hysteroscopy in combination with B-ultrasound examination is a major option for duplex uterus diagnosis, and hysteroscopic transcervical resection of septum and vaginal septum resection under B-ultrasound monitoring is the primary surgery treatment alternative for duplex uterus.

Low-Dose Spinal Anesthesia with Hyperbaric Bupivacaine with Intrathecal Fentanyl for Operative Hysteroscopy: A Case Series Study

Study Objective To estimate the efficacy and tolerability of low dose spinal anesthesia during operative hysteroscopy in a group of patients with high surgical risks. Design Case series study (Canadian Task Force Classification II-2). Setting Tertiary centers for women health care. Patients A total of 47 women affected by endometrial polyps (n = 32), myomas (n = 8), and abnormal uterine bleeding (n = 7) scheduled for inpatient operative hysteroscopy. Interventions Transvaginal ultrasonography; office diagnostic hysteroscopy; preoperative evaluation of American Society of Anesthesiologist (ASA) classification; inpatient operative hysteroscopy; low-dose spinal anesthesia with hyperbaric bupivacaine; compilation of a questionnaire. Main Outcome Measures Practicability and patients’ subjective experiences with spinal anesthesia; duration of cervical dilation and for operative hysteroscopy; infusion volume needed; incidence of surgical complications. Results Resectoscopy was performed in all patients, with the exception of 1 woman (2.1%) in which spinal anesthesia was unsuccessful. No statistically significant differences were noted among groups in terms of intra- and peri-operative findings. Sensory block induced by spinal anesthesia was suitable for surgery in all patients, and side effects occurred far less frequently than mentioned in the literature. Data reported in the questionnaire revealed that 93.5% of women would choose a spinal anesthesia again for a potential operative hysteroscopy in the future, since for 89.1% of them long lasting anesthesia is of relevance. Conclusions Low-dose spinal anesthesia is a feasible technique in the inpatient setting for operative hysteroscopy in women with high surgical risks.

Increased Difficulties and Complications Encountered During Hysteroscopy in Women with Genital Tuberculosis

Background Genital tuberculosis (TB) in women is a common disease in developing countries, and hysteroscopy and laparoscopy are vital tools in diagnosis. Study Objective To retrospectively compare the difficulties encountered and complications of hysteroscopy in women with and without genital TB. Design Case-control clinical audit (Canadian Task Force classification II-1). Setting Medical college and hospital. Patients Ninety-nine women who underwent hysteroscopy, with or without other procedures, who were found to have genital TB at various investigations (group 1) and 289 women who underwent hysteroscopy during the same period with similar characteristics but without evidence of genital TB (group 2, controls). Intervention Hysteroscopy. Measurements and Main Results Difficulties encountered and complications observed were recorded, compared, and analyzed using the χ 2 and Fisher exact tests. Indications for hysteroscopy in the study vs the control group were infertility in 92 patients (92.92%) vs 124 (42.90 %), amenorrhea in 6 (6.66%) vs 12 (4.15%), and postmenopausal bleeding in 1 (1.11%) vs 29 (10.03%). Difficulties and complications were significantly higher in group 1. Inability to distend the cavity was observed in 8 women in group 1 (8.08%) vs 2 in group 2 (0.69%). Excessive bleeding was observed in 5 women in group 1 (5.05%) vs 1 in group 2 (0.35 %). Uterine perforation was observed in 8 women in group 1 (8.08%) vs 5 in group 2 (1.73%), and flare-up of genital TB was observed in 1 woman in group 1. Conclusion Hysteroscopy in women with genital TB is associated with difficulty in performing the procedure and with higher rates of complications.