Uterine Cavity Abnormalities Research Articles

Diagnostic accuracy of transvaginal ultrasonography and hysterosalpingography in the detection of uterine cavity pathologies among infertile women.

Uterine cavity pathology may affect the endometrium or myometrium, resulting in distortion of the uterine cavity, and is responsible for 2%-5% of infertility. The methods for its assessment usually involve imaging modalities like pelvic ultrasonography, often transvaginal-(TVS), and hysterosalpingography-(HSG), with hysteroscopy-(HSC) as the gold standard. However, HSC is not readily available in resource-poor-settings. To determine and compare the diagnostic accuracy of TVS and HSG in detecting uterine cavity pathology using HSC as a gold standard. A cross-sectional analytical study of consenting infertile women for evaluation of the uterine cavity using transvaginal-ultrasonography, hysterosalpingogram, and hysteroscopy. The primary-outcome-measures were the sensitivity, specificity, and accuracy of TVS and HSG in detecting uterine cavity abnormalities using HSG as the gold standard. Eighty-eight participants were analysed for this study. The lesions confirmed on HSC were intrauterine-adhesions (43.1%), endometrial polyps (14.8%), submucous fibroids (18.2%), intrauterine-septum (13.6%), and cavity distortion (14.8%). The overall sensitivity with TVS was 57.7%, with a specificity of 97.6%, a positive-predictive-value (PPV) of 88.2%, and a negative-predictive-value (NPV) of 88.2%, giving a percentage-accuracy of 88.2%. In comparison, HSG had a sensitivity of 72.1%, a specificity of 99.4%, a PPV of 97.4%, and an NPV of 92.0%, giving an overall accuracy of 92.9%. The detection rates of TVS and HSG in this category were: fibroids (97.7% vs 89.8%; p = .0004) and adhesions (73.9% vs 87.5%; p = .0002), respectively. HSG appears to be the superior modality for detection of obliterative uterine cavity pathologies, while TVS is better suited for myometrium and endometrial lesions.

Computer-Aided Diagnosis System Based on Deep Learning for Diagnosis of Atypical Endometrial Hyperplasia and Endometrial Cancer on Hysteroscopy

Hysteroscopy is an effective tool to diagnose and treat abnormal uterine bleeding or uterine cavity abnormalities, especially precancerous or cancerous disorders. In this study, we proposed an Endometrial Cancer (EC) Computer-Aided Diagnosis System (ECCADx) based on deep learning to boost the diagnostic accuracy for recognizing Atypical Endometrial Hyperplasia (AEH) and EC. ECCADx was developed using a training dataset with 49,646 images from 1,237 patients in Maternal and Child Hospital of Hubei Province (MCH) and two test datasets with 7,243 images from 209 patients in MCH, Tongji Hospital (TJH), and The Second Affiliated Hospital of Zhengzhou University (ZZSH). We compared the diagnostic efficiency between the proposed system and eight gynecological endoscopists from two different hospitals (MCH and TJH) using a hospital cross-testing method. The sensitivity, specificity and AUC of ECCADx were 92.8% (95% CI 85.7-100%), 92.5% (95% CI 86.7-98.3%), and 0.965 (95% CI 0. 931-1) on MCH test dataset (internal data), respectively, superior to two gynecological endoscopists and having no significant difference compared with the other two endoscopists at TJH. For TJH/ZZSH test dataset (external data), the sensitivity, specificity and AUC were 75.2% (95% CI 59.5-90.8%), 95.2% (95% CI 91.5-99.0%), and 0.881 (95% CI 0.789-0.967), respectively, superior to three gynecological endoscopists and having no significant difference compared with the other endoscopist at MCH. ECCADx demonstrated excellent performance in identifying AEH and EC in test datasets from different medical centers. The effectiveness of ECCADx was comparable or even better than those of experienced gynecological endoscopists.

Sonohysterography Assessment of the Structural Abnormalities of the Uterus in Women with Infertility in Ethiopia

Background: Female factor infertility is associated with a high incidence of the uterine cavity and fallopian tube pathology in developing countries with a high prevalence of STDs, therefore various methods are available for structural evaluation of the female reproductive system, among them is saline infusion sonohysterography (SISHG). The study aimed to assess the role of SISHSG in female infertility evaluation in areas where the gold standard investigating modalities are not readily available.
 Methods: A hospital-based cross-sectional study was carried out in Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia, between January 2019 to August 2019 G.C. SISHSG consists of instillation of saline into the endometrial cavity with simultaneous pelvic ultrasonography (US). Fifty consecutive female patients referred to the Radiology Department for SISHSG are included in the study. Sensitivity, specificity, positive and negative predictive values were calculated for 26 patients who had both SISHSG and conventional HSG.
 Result: The majority of the patients were in the age group of 35-40(38%) and 34 (68%) had secondary infertility. The commonest abnormalities detected were uterine myoma 10(20%), Asherman syndrome/cervical stenosis 7 (14%), and tubal blockage 6(10%). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of SISHSG in normal study, Asherman syndrome/cervical stenosis and chronic endometritis was 100%, as compared to the gold standard conventional HSG. For bilateral tubal blockage the SISHSG had 50% sensitivity, 90% specificity, 66.7% PPV and 81.8% NPV, however, for unilateral tubal blockage SISHSG had low sensitivity 33%.
 Conclusion: SISHSG is readily available, easy-to-do, safe and radiation-free procedure and has high sensitivity and specificity in detecting uterine cavity abnormality. We advocate its use as a first step of investigation modality in the evaluation of female infertility.

Detection of uterine abnormalities using three-dimensional vaginal ultrasound in infertile women undergoing assisted reproductive techniques

Abstract Background: Uterine shape and cavity abnormalities form a common cause of subfertility, for which thorough assessment is considered as a core part in infertility evaluation. A variety of modalities (invasive and none invasive) such as hysterosalpingography, transvaginal sonography, diagnostic hysteroscopy, two-dimensional hysterosonography, and three-dimensional hysterosonography can be used for the diagnosis of uterine abnormalities. Objectives: To address the detection rate of uterine and endometrial abnormalities in infertile women undergoing assisted reproductive techniques (ART) using three-dimensional vaginal ultrasonography. Materials and Methods: A cross-sectional observational study that involved 211 subfertile women who were arranged to undergo ART for different causes of infertility. After taking their verbal consent for participation in this study, all women examined by 2D vaginal U/S for initial assessment of their pelvic anatomy then followed by three-dimensional U/S with or without saline infusion for further assessment of the uterine and endometrial cavity morphology. Women with ultrasound detected endometrial abnormalities further underwent hysteroscopic assessment, histopathological specimens were taken and were treated as recommended by their gynecologist. Results: Twenty-two percent of the studied group discovered to have uterine and/or endometrial abnormalities including endometrial polyps and uterine myomas are the most commonly detected abnormalities while congenital uterine malformation detected in 3.8% of the total patients using three-dimensional ultrasonography. Conclusion: Uterine and endometrial abnormalities are common in subfertile patients, the prevalence of uterine and endometrial abnormalities (endometrial polyps or irregularities, uterine myomas including submucous one) was 22%, whereas congenitally maldeveloped uteri were detected in 3.8% of women undergoing ART (using 3D U/S) which may have a negative impact on ART outcome.

Comparative Study Between Three-Dimensional Transvaginal Ultrasonography and Hysteroscopy In The Diagnosis Of Uterine Cavity Abnormalities In Infertile Women

Comparative Study Between Three-Dimensional Transvaginal Ultrasonography and Hysteroscopy In The Diagnosis Of Uterine Cavity Abnormalities In Infertile Women

Utility of Repeat Uterine Cavity Evaluation in the Infertility Workup.

Background: Uterine cavity abnormalities contribute to infertility. The purpose of this study was to evaluate the incidence, recurrence rates, and risk factors for uterine cavity abnormalities in women undergoing infertility workup and treatment, focusing on the utility of routinely repeated imaging. Methods: Retrospective cohort study at single academic medical center of 833 infertile women who had uterine cavity evaluations performed at least 9 months apart. Results: Of 833 eligible patients, 664 (79.7%) had normal initial imaging and 169 (20.3%) had abnormal initial imaging. Among the former, 10% had abnormal uterine cavity on repeat saline infusion sonohysterography (SIS); among the latter, 32% had abnormal repeat SIS [Chi-square p < 0.0001, risk ratio 2.30 (95% confidence interval 1.85-2.86)]. On average, 23.1 ± 13.6 months passed between studies. Regardless of initial imaging findings, women with abnormal repeat SIS were older than those with normal repeat SIS, with no difference in time elapsed between studies. There were no associations between repeat imaging outcomes and body mass index, uterine instrumentation, number of treatment cycles, or maximum peak estradiol levels in a single cycle between studies. There was no difference in live birth rate among cycles started within 1 year after repeat SIS across groups. Conclusions: Uterine cavity abnormalities were found in 10% of patients on repeat imaging despite initially normal testing. No risk factors for cavity abnormality on repeat imaging were identified besides age and prior abnormality. It would be prudent to continue performing routine repeat uterine cavity evaluation for women undergoing fertility treatment, particularly if corrective measures had been taken in the past.

#196 : Office Hysteroscopy Results in Patients with Recurrent Implantation Failure at Tam Anh General Hospital

Background and Aims: To describe the clinical characteristics and evaluate the results of office hysteroscopy in patients with recurrent implantation failure at Tam Anh General Hospital. Methods: A descriptive study on 151 patients at Tam Anh General Hospital who had failed embryo transfer twice or more consecutively was carried out from January 2021 to March 2023. Results: 151 patients were included in the study, 41,1% of which had unexplained infertility. The mean age and duration of infertility were 34,5 ± 5,2 years and 5,7 ± 3,4 years, respectively. 55,0% of patients exhibited uterine cavity abnormalities during office hysteroscopy, with the most common is endometritis accounting for 29.8%. The median time to perform the procedure was 3 (2) minutes, the mean VAS pain score was 3,2 ± 1,1 points. No complications related to office hysteroscopy were noted. Conclusions: A office hysteroscopy was able to detect intrauterine pathologies which were missed by other investigative modalities. In individuals who have experienced repeated implantation failure, office hysteroscopy is a safe and practical approach that should be recognized as a crucial tool for intrauterine evaluation.

#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.

What is the Optimum Endometrium Needed for Implantation?

Implantation most critical step in reproduction. A complex process where blastocyst becomes intimately connected with maternal endometrium/decidua and requires; Competent embryo at blastocyst stage Receptive endometrium Synchronized dialogue between maternal and embryonic tissues Endometrial Changes for Implantation include architectural, morphological, cytochemical, molecular and genetic. These Changes Induce Endometrial receptivity, which is endometrial lining in a state of readiness for blastocyst implantation. It involves acquisition of adhesion ligands and loss of inhibitory components that may act as a barrier to an attaching embryo. Receptive endometrium is capable of selecting good quality embryos and reject the incompetent embryos. Endometrial Evaluation includes 1. Non-Invasive Assessment of Endometrial Receptivity by USG 2. Detection of abnormal Uterine cavity by 3D USG/SIS, HSG and Hysteroscopy 3. Diagnose Chronic Endometritis by hysteroscopy and Molecular tests? 4. Endometrial Microbiome by molecular tests 5. Endometrial asynchrony - Proteomics and transcriptomics 2D and 3D Ultrasound can Identify patients with poor implantation prognosis but has low predictive value in determining endometrial receptivity and IVF outcome. Ideal endometrial thickness for optimal outcome is between 7-14 mm. No Association was seen between clinical pregnancy rates (CPR) and endometrial pattern for women undergoing in IVF with fresh ET and FET. Minimum Endometrial Volume associated with pregnancy is 1.59 mL – 3D. But most pregnancies occur in volumes of 2-13 mL. Evaluation of endometrial volume is particularly useful in synechiae, adenomyosis and uterine anomalies. Vascularity demonstrated within Zone 3 or within Zones 3 and 4 prior to transfer is associated with good implantation rate. Presence of &gt;3 peristaltic contractions of the sub endometrial myometrium/2 minutes interval on Day of hCG administration associated with poor implantation. Diagnosis of chronic endometritis is based on hysteroscopy, endometrial biopsy with plasma cells being identified histologically and specific treatment is determined based on microbial culture. Existence of non-Lactobacillus bacteria in the endometrium is correlated with negative impacts on reproductive function and should be considered as an emerging cause of implantation failure and pregnancy loss. Endometrial Receptivity Array (ERA) is validated for analysing the expression of 238 genes that are intimately related to endometrial receptivity. Abnormality in endometrial receptivity is displayed a specific gene expression profile. Intrauterine secretory profile directly linked to successful implantation and evaluation of endometrial fluid for cytokine, interleukin and growth factor secretions can be used to assess the endometrium. Conclusion: Identification of one or more of endometrial parameters that definitely indicate receptivity for implantation remains an elusive goal. None of the endometrial receptivity markers have sufficient discriminatory value to act as a diagnostic test for endometrial receptivity based on their ability to predict clinical pregnancy. Due to the dynamic, cyclic nature of the endometrium it may be difficult, to reliably assess endometrial function on the basis of a single test.

Causes of Infertility among the Couples Who are Attending the Infertility OPD of BSMMU

Introduction: Infertility may be defined as inability to conceive within one year of unprotected regular coitus. Approximately 85 – 90% of healthy young couples conceive within 1 year, most within 6 months1. Infertility therefore affects approximately 10 – 15% of couples and represents an important part of clinical practice2. A general classification of causes of infertility are male 35 – 40%, female 40 – 50% (tubal 25%, ovulatory 20% and cervical 1 – 2%), sexual 10% and unknown 10%3. More than one factor per couple accounts for the total percentage appearing to exceed 100%. Objective: To assess the determinants of infertility among the infertile couples both male and female attending the outpatient department of infertility unit of the department of obstetrics and gynaecology of Bangabandhu Sheikh Mujib Medical University , Shahbagh, Dhaka. Materials &amp; Methods: This prospective observational study was conducted in the Infertility unit, Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, during the period from 01.07.2018 to 31.12.2021. Five hundred infertile couples were recruited from the out-patient department of infertility unit who came to take treatment for their infertility problem. Data were collected from the couples by data collection sheet and the data were plotted in the tables. The data were analyzed by SPSS program, version 28. Results: The socio-demographic characteristics of the study subjects (n = 500).Husbands age group was 22 -55in years, Mean ± SD (34.0 ± 5.9). Age of the female partners was 18 – 44 years, mean ± SD (27.1 ± 5.2). Majority of the female study subjects had secondary level of education (49.4%), where as in male study subjects secondary level of education was 30.4%, followed by graduates (29.6%). Occupation of female partners was mostly housewife = 395 (79.0%), occupation of male partners was mostly service = 356 (71.2%). Regarding religion, Muslims were 476 (95.2%), others were 24 (4.8%). Majority of them hailed from rural area (62%). According to BMI, majority of female were overweight (56%). Among the respondents, majority of them had primary infertility (59.8%) and the rest (40.2%) had secondary infertility. Regarding hormonal status of infertile women, most of them (94%) had serum FSH below normal (&lt; 3U/L), serum LH below normal (&lt; 2U/L) in 96% patients, Serum TSH above normal (&gt;4.5 mU/L) in 49.0% patients, serum FT4 above normal (&gt;21 pml/L) in (60.8%) patients, serum Prolactin level above normal (&gt;630 mU/L) in 27.8) patients. Diabetes: In male = 28 (5.6%).Mumps: In male = 7 (1.4%). Chicken pox: In male = 18 (3.6%). Hypertension: In male = 10 (2.0%). Orchitis: In male = 6 (1.2%). Personal history of husband: Smoking = 129 (25.8%). In male patients, Testosterone level normal (10 – 30 nmol/L) in 133 (26.6%) patients and above normal (&gt;30 nmol/L) in 367 (73.4%) patients. The semen analyses of the husbands of the infertile female patients shows, quality of semen poor (&lt;4%) in 305 (61%) patients. Regarding semen quality, oligospermia (&lt;15 million/ml) was in 480 (96%) patients and azospermia (0% count) in 20 (4%) patients. In case of motility of sperms, rapid linear below normal (&lt;50%) was in 90 (18%). In case of slow linear (SL), below normal (&lt;15%) in 324 (64.8%) patients. In case of morphology of sperms, below normal (&lt;14million/ml) in 25 (5%) patients. Regarding structural abnormalities of female organs bicornuate uterus was found in 15.2% patients, abnormal uterine cavity in 11.4% patients. In 13.0% patients’ abnormal right ostium were found and in 12.6% patients’ abnormal left ostium were found. Intrauterine adhesion was found in 35.2% patients and submucus fibroid in 17.6% patients. Abnormal right fallopian tube was found in 33.2% patients and abnormal left fallopian tube was found in 34.2% patients. Dye test in 42.4% patients were negative that means the tubes were blocked. Conclusion: This study shows that a significant percentage of both male and female are suffering from infertility. The major causes of male infertility are partly hormonal, structural abnormalities of male genitalia, infection of genital tract, and partly psychological.Causes of female infertility are mostly hormonal, structural abnormalities of the uterus, fallopian tubes, infection of the genital tract and partly psychological. Medicine Today 2023 Vol.35(1): 20-26

Effect of Parity on Placental Histopathology Features in Singleton Live Births Following IVF.

The aim of this study was to evaluate the effect of parity (primipara vs multipara) on the histopathology of the placenta in singleton live births following in vitro fertilization. We conducted a retrospective cohort study evaluating data of all IVF resulted live births from one university affiliated hospital during 2009-2017. All patients had the placenta sent for pathological evaluation. Exclusion criteria were history of miscarriage or elective termination of pregnancy, abnormal uterine cavity findings, previous uterine surgery, in vitro maturation cycles, gestational carrier cycles, oocyte recipient cycles, preimplantation genetic diagnosis cycles, and multiple pregnancies. The outcomes measured included anatomical, inflammation, vascular malperfusion, and villous maturation placental features. A multivariate analysis was conducted to adjust the results for factors potentially associated with placental pathology features. A total of 395 live births were included in the final analysis and were allocated to the study groups according to parity: primipara (n = 273) and multipara (n = 122). After adjustment for potential confounding factors, multiparity was found to be significantly associated with delayed villous maturation (OR 4.9; 95% CI 1.2-19.8) and primiparity was significantly associated with maternal vascular malperfusion (OR 0.6; 95% CI 0.3-0.8). We showed that parity has an impact on placental histopathological changes which in turn may affect perinatal outcome.

Determinants of Infertility among Married Couples in a Tertiary Hospital in Bangladesh

Introduction: Infertility is a common issue among married couples in Bangladesh. Infertility is often caused by a combination of multiple factors, and that individual cases of infertility can be complex and difficult to diagnose. Objective: To assess the determinants of infertility among the infertile couples both male and female. Materials and Methods: This prospective observational study was conducted in the Infertility unit, Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, during the period from 01.07.2018 to 30.31.12.2021. Five hundred infertile couples were recruited from the out-patient department of infertility unit who came to take treatment for their infertility problem. Results: Mean (± SD) age of the female patients was 27.1 ± 5.2 years ranged between 18-44 years. Mean (± SD) age of the husband of patients was 34.0 ± 5.9 years ranged between 22-55 years. Primary infertility was seen in 59.8% study subjects and secondary infertility was seen in 40.2% study subjects. In our study, most of the women (94%) had below normal (&lt;3 U/L) serum FSH. Most of the women (96%) had below normal (&lt; 2U/L) serum LH. Serum TSH was normal (0.2 – 4.5 mU/L) in 51.0% patients. Majority of the women (60.8%) had above normal (&gt;21 pml/L) serum FT4 level. Most of the women 72.2% had normal serum prolactin level. In male patients, Testosterone level was above normal (&gt;30 nmol/L) in majority of the patients (73.4%). In Hysterosalpigography (HSG), 0.40% had abnormal uterine cavity, 4.2% had septed uterus, 15.2% had bicornuate uterus, 1.0% had unicornuate uterus and 1.6% had endometrial polyp. Hysteroscopy found abnormal uterus in 1.2% of patients, abnormal uterine cavity in 11.4%, abnormal endometrial flakes in 12.4%, abnormal right ostium in 13.0% and abnormal left ostium in 12.6%. Intrauterine adhesion, polyp and submucus fibroid were found in 35.2%, 2.8% and 17.6% respectively. Laparoscopy found abnormal uterus in 3% patients, abnormal right fallopian tube in 33.2%, abnormal left fallopian tube in 34.2%. Also, abnormal right fallopian tube in 37.0% and abnormal left fallopian tube in 37.6%. Pouch of Douglas free was found in 63%. During dye test in laparoscopy, 57.6% patients were found positive. In quality, semen type was found poor (&lt;4%) in majority (61%) of the husbands. Regarding semen count, above normal (&gt;20 million/ml) level was found in majority of the patients (80.8%). Regarding semen quality, majority (96%) had oligospermia (&lt;15 million/ml). In case of rapid linear (RL), normal (50-60%) level was seen in majority of the patients (81.6%). In case of slow linear (SL), below normal (&lt;15%) was seen in majority (64.8%) of the patients. Regarding non-propagative (NP), normal (0-10%) level was seen in most of the (87.8%) patients. In case of morphology of sperms, above normal (&gt;50 million/ml) level was seen in most of the patients (80.6%). Conclusion: This study shows that a significant percentage of both male and female are suffering from infertility. The major causes of male infertility are partly hormonal, structural abnormalities of male genitalia, infection of genital tract, and partly psychological. Causes of female infertility are mostly hormonal, structural abnormalities of the uterus, fallopian tubes, infection of the genital tract and partly psychological.

Hysteroscopic findings in cases of secondary infertility after cesarean section

BackgroundCesarean section (CS) is a common procedure nowadays. Although being essential in many conditions, CS has short-term and long-term complications. One of the long-term complications is infertility. Presence of a previous CS raises the possibility of uterine factor as a contributing cause of infertility. Hysteroscopy is the gold standard method to assess the uterine cavity. It can identify some abnormalities missed by hysterosalpingography or ultrasound.Patients and methodsA prospective observational study was conducted that included 56 women with complaint of secondary infertility after CS. Office hysteroscopy was done for all women to assess the uterine cavity and to find out any subtle abnormalities in these women. The authors excluded women with clear causes of infertility and medical disorders that may preclude the hysteroscope, such as epilepsy, cardiac diseases, and women with active cervical or uterine infection.ResultsAll participating women did not have an apparent cause of infertility. A total of 25 (44.7%) patients had normal hysteroscopic findings and 31 (55.3%) patients were found to have abnormal findings: nine (16.1%) patients with uterine niche, eight (14.3%) patients with endometrial adhesions, seven (12.5%) patients with endometrial polyp, four (7.1%) patients septate uterus, and three (5.4%) patients with submucous myoma.ConclusionThe study showed that a high proportion of patients with secondary infertility after CS have uterine cavity abnormalities that warrant hysteroscopic examination, but further study is needed to evaluate the pregnancy outcome of correction of these abnormalities.

Comparison of Four Dimensional Transvaginal Sonography Versus Hysteroscopy in Assessment of Abnormal Uterine Cavity in Infertile Women

Comparison of Four Dimensional Transvaginal Sonography Versus Hysteroscopy in Assessment of Abnormal Uterine Cavity in Infertile Women

Frozen-Thawed Blastocysts Transfer Cycle in Patients with Dysmorphic Uteri After Hysteroscopic Metroplasty: A Case-Controlled Study in a Single In-Vitro Fertility Center

Objective: Dysmorphic uterus, a rare uterine malformation characterized by an abnormal uterine cavity, may lead to reproductive failures, such as infertility and adverse pregnancy outcomes. Results of hysteroscopic correction of this uterine malformation on reproductive outcomes are poorly reported. This study evaluated reproductive outcomes of frozen-thawed electives single-blastocyst transfers (eSBTs) in patients who underwent hysteroscopic metroplasty for dysmorphic uteri, and compared these results with those of a control group. Materials and Methods: This study included 78 patients with primary infertility who had dysmorphic uterine anomalies and 379 age- and body mass index–matched infertile patients with normal uterine cavities (controls). All patients were enrolled in an in-vitro fertilization program. Selected top/good-quality blastocysts were frozen and then transferred in another cycle after hysteroscopic metroplasty. Reproductive and obstetric outcomes of all cases and characteristics of frozen embryo transfer (FET) cycles were analyzed retrospectively. Results: Demographic characteristics of both groups were similar. There were no statistically significant differences between the study and control groups for implantation rates, clinical pregnancy rates, and live birth rates (LBRs): 63.2% versus 64.8%, 57% versus 55%, and 39.8% versus 40.3%, respectively; all p > 0.05. Rates of clinical pregnancy losses were higher in the study group, but this difference was not statistically significant (27.1% versus 19.5%; p > 0.05). Preterm deliveries were significantly higher in the study group than in the control group (23.5% versus 10.9%; p = 0.03). Type of endometrial preparation, day of embryo transfer, and grade of transferred embryos were similar in both groups, except endometrial thickness was significantly lower in the study group (8.9 ± 1.4 mm versus 10.1 ± 1.7 mm; p < 0.001). Conclusions: Patients who underwent hysteroscopic metroplasty of the uterine cavity, reproductive outcomes of FET cycles as were successful as in patients with normal uterine cavities. eSBTs with top/good quality embryos after hysteroscopic metroplasty in patients with dysmorphic uteri improves LBRs but preterm births are higher, compared to patients with normal uterine cavities. (J GYNECOL SURG 39:36)

The menstrual cycle phase impacts the detection of plasma cells and the diagnosis of chronic endometritis in endometrial biopsy specimens

To assess the impact of menstrual cycle phase on the detection of plasma cells. A retrospective cohort study. Fertility clinic. Biopsies from 157 patients met criteria for inclusion, 91 in the follicular phase and 60 in the luteal phase. Patient groups were similar in body mass index and number of previous live births; however, differed in terms of age, infertility history, and biopsy indication. Endometrial biopsies from patients at a fertility clinic from 2018-2020 were retrospectively reviewed. Biopsies were excluded if patients had a previous chronic endometritis diagnosis, abnormal uterine cavity or were on hormone therapy. Each case was reviewed by a gynecologic pathologist for plasma cells by hematoxylin and eosin and CD138 staining. Demographic and clinical data were collected. Continuous variables were compared using Welch t test and Wilcoxon's rank sum test, and categorical variables using Pearson's χ2 test. Logistic regression was used to calculate odds ratio and 95% confidence intervals for the association between the presence of plasma cells and cycle phase. Multinomial logistic regression was used to estimate the odds ratios for nominal outcomes. Pathology reports were reviewed. Plasma cell enumeration using hematoxylin and eosin-stained sections and CD138 immunohistochemical stains (performed at the time of biopsy by a gynecologic pathologist) was recorded. Presence and density of plasma cells. We found a higher likelihood of finding plasma cells in the follicular than in luteal phase (59.3% vs. 19.7%). There was a higher likelihood of finding plasma cells in the early (cycle days 5-8, 29 cases or 76.3% of cases with plasma cells) than in the late follicular phase (cycle days 9-14, 25 cases or 47.2%). There was a higher density of plasma cells in the follicular phase group than in the luteal phase group (25.3% vs. 1.5% scattered and 13.2% vs. 0 clusters). Plasma cells are more likely to be present during the follicular phase compared with the luteal phase and in the early compared with the late follicular phase. Further studies are needed to identify the optimal timing of biopsy to standardize the diagnosis.

O-057 The pregnant outcome after laparoscopy treatment for subtle distal fallopian tube abnormalities in infertile population: a prospective cohort study

Abstract Study question What is the the pregnancy outcome after laparoscopy treatment for subtle distal fallopian tube abnormalities and the factors related with natural pregnancy. Summary answer The natural pregnancy rate is 46.58% after laparoscopy and patients' age, duration time of infertility and concurrent number of abnormalities are related with natural pregnancy. What is known already Subtle distal fallopian tube abnormalities are a group of diseases that are characterized by subtle variations in tubal anatomy including fimbrial agglutination, tubal diverticula, accessory ostium, fimbrial phimosis, and accessory fallopian tube. The prevalence of subtle distal fallopian tube abnormalities is high in infertile women.This group of diseases is highly related to endometriosis, especially its early stage, and may indicate fimbrial abnormalities in endometriosis. Study design, size, duration This was a prospective cohort study conducted in the Reproductive Medicine Center of an university-affiliated teaching hospital from January 2017 to December 2018. Participants/materials, setting, methods 234 patients with subtle distal fallopian tube abnormalities were included. Laparoscopies were performed by four senior reproductive surgeons who were familiar with the diagnostic criteria and surgery treatment for subtle abnormalities. The fallopian tube abnormalities were corrected and endometriosis was treated by either electrical ablation for peritoneal lesions or endometrioma excision.The participants were followed up by phone every 12 months for pregnancy outcome until 36 months after surgery. Main results and the role of chance 167 patients conceived after surgery(clinical pregnancy rate 71.37%). 109 patients conceived naturally (natural pregnancy rate 46.58%) and 59 patients conceived after in IVF（One case conceived naturally after live birth after IVF, four cases conceived naturally twice) . The average time for natural conception after surgery is 8.36±7.47 months. 51.4% of natural pregnancy occurred within 6 months and 79.8% occurred within 12 months.Among the 109 naturally conceived patients, there were 94 cases of live birth, 13 cases of natural abortion (natural abortion rate 11.92%) and 2 cases of ectopic pregnancy (ectopic pregnancy rate 1.83%). No preterm birth, multiple pregnancy or birth defects were reported in this group.The patient age(HR = 0.917,95%CI 0.870-0.917,P=0.001), duration of infertility(HR = 0.846,95%CI 0.740-0.966,P=0.014) and concurrent number of subtle abnormalities (HR = 0.636,95%CI 0.416-0.970,P=0.036) are the factors associated with natural pregnancy. The type of subtle abnormalities, type of infertility, body mess index, concurrent endometriosis, uterine cavity abnormalities and myoma are not related with natural pregnancy. Limitations, reasons for caution Not all kinds of subtle distal abnormalities are included such as paratubal cyst is excluded from the study. Not all the patients had the test of ovarian reserve such as AMH, antral follicle count and FSH level, so we couldn’t evaluate the relationship between ovarian reserve and natural pregnancy. Wider implications of the findings This is the largest clinical study that investigated the pregnancy outcome of subtle fallopian tube abnormalities in the infertile population.Laparoscopy surgery is an effective treatment for infertility patients with subtle distal fallopian tube abnormalities, especially for the young, short duration time of infertility and ≤2 types of subtle abnormalities. Trial registration number ChiCTR2000029095

P-366 Tumor necrosis factor-alpha and milk fat globule-epidermal growth factor 8: novel biomarkers to predict implantation failure and pregnancy loss

Abstract Study question Can implantation failure (IF) and pregnancy loss be predicted in serum prior to in vitro fertilization (IVF)? Summary answer Tumor necrosis factor (TNFα) and milk fat globule-epidermal growth factor 8 (MFG-E8) levels may serve as serum markers to predict IF and pregnancy loss. What is known already In a normal pregnancy, mediators such as TNFα are released creating a physiological inflammatory response. However, an exaggerated release of TNFα has been associated with IF and recurrent pregnancy loss (RPL). Recent studies demonstrated that TNFα up-regulates the expression of inflammatory factors such as MFG-E8. MFG-E8 is known to modulate implantation by acting at various levels of the trophoblast and endometrial compartments. Hence an overexpression of this protein may result in apoptosis, endometrial damage, and impaired implantation. Study design, size, duration This multicentric prospective controlled pilot clinical study was conducted from January 2016 to January 2020 and included 30 women in their natural cycle in which serum MFG-E8, TNFα, estradiol (E2), and progesterone (P4) levels were quantified in the early proliferative (cycle day 2) and secretory phases (urinary LH + 7 days). Additionally, an endometrial biopsy was obtained on urinary LH + 7 days for MFG-E8 and TNF α protein and gene expression analysis. Participants/materials, setting, methods Women ages 21-35y were recruited from 3 groups: fertile controls (C), unexplained IF (following 3 failed good quality embryo transfers), and RPL (at least 2 unexplained first trimester miscarriages). Patients with history of uterine surgery, abnormal uterine cavity (fibroids, endometrial polyps, adhesions, adenomyosis, and congenital uterine abnormalities), hydrosalpinx, diminished ovarian reserve, harboring chromosomal rearrangements, thrombophilia, or autoimmune diseases were excluded. Main results and the role of chance Ten women were included in each group. No statistical differences were found in age, BMI, AMH, baseline FSH, and baseline antral follicle count among cohorts. Mean serum E2 and P4 levels were similar among all groups in both the proliferative and secretory phases: E2 proliferative (C 69.19±26.64 pg/ml, IF 64.19±32.56 pg/ml, RPL proliferative 57.44±38.51; p = 0.55), E2 secretory (C 164.10±52.57 pg/ml, IF 172.57±121, RPL 173.81±.97.35; p = 0.25), P4 proliferative (C 0.45±0.15 ng/ml, IF 0.45±0.19 ng/ml, RPL 0.53±0.18 ng/ml; p = 0.85), P4 secretory (C 7.42±4.06 ng/ml, IF 7.8±4.56 ng/ml, RPL 8.05±4.38 ng/ml; p = 0.74). Mean serum TNFα levels were significantly higher in both, the proliferative and secretory phases for the RPL group (proliferative RPL 9.98±4.47 pg/ml, IF 4.73±2.56 pg/ml, C 3.42±1.01 pg/ml; p = 0.001 vs secretory RPL 8.67±4.45 pg/ml, C 3.35±0.94 pg/ml, IF 3.85±1.01 pg/ml; p = 0.03). Mean serum MFG-E8 levels were significantly higher in the IF group during the proliferative phase (IF 373±201 pg/ml, RPL 201±115 pg/ml, C 225.58±109.73pg/ml; p = 0.03), but not in the secretory phase (IF 237±101 pg/ml, RPL 189±116 pg/ml, C 199.41±112.43 pg/ml; p = 0.15). Endometrial MFG-E8 mRNA levels were significantly lower in the IF and RPL group compared to C (p = 0.03). TNFα mRNA levels were not statistically significant among groups (p = 0.12). Limitations, reasons for caution This is a pilot study to assess feasibility. Due to the small sample size, the effects of more subtle covariates would not have been detected. Future larger studies are warranted. Wider implications of the findings These novels differentially expressed serum and endometrial markers may provide information on the physiology of implantation and could generate the basis for non-invasive diagnostic tools and therapeutic use of MFG-E8/TNFα antagonists in women with IF and RPL. Trial registration number IIT-2014-100366

Is hysteroscopy justified in infertile women?

This retrospective study aimed to assess the value of Hysteroscopy (HS) in studying the rate and types of abnormalities found in uterine cavity during evaluation of infertile patients in comparison to hysterosalpingography (HSG). Subject and Methods: this study included 149 infertile women underwent HS for primary &amp; secondary infertility, recurrent abortions and failed IVF cycles at Department of Obstetrics &amp; Gynecology at Zliten teaching Hospital, Misurata center for Diagnosis and treatment of Infertility . Preoperative assessment: history, pelvis evaluation with necessary investigations including ultrasound and HSG. Data were analysed in terms of type &amp; rate of abnormality found, their relation with age and type of infertility including correlation between HSG and HS findings. Results: Abnormalities of uterine cavity were detected in more than half of the patients studied (59%), significantly more at ages of 31-42 years (58.3%) when compared with ages of 20-30 years (34.6%),(P&lt;0.05). Endometrial polyps (20.4%), septate and subseptate uterus (17.2%). Submucous myomas, cornual polyps and intrauterine adhesions were seen at same rate (6%),. Most of the pathologies were seen in primary infertility patients except the intrauterine adhesions which exclusively found in those with secondary infertility.

Complex Uterine Cavity Abnormalities Increase the Risk of Miscarriage in In Vitro Fertilization/Intracytoplasmic Sperm Injection in Fresh Cycle-Assisted Pregnancies

Any abnormality of the uterine cavity can result in reduced endometrial receptivity, which negatively affects embryo implantation and leads to lower clinical pregnancy rates. The effects of improved uterine cavity environment on in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI)-embryo transfer (ET) treatment outcome are unclear. This study aimed to investigate the impact of improved uterine cavity abnormalities on the pregnancy outcomes of infertile patients undergoing IVF/ICSI-ET. Retrospective study. Single-center. Women with infertility who underwent fresh cycles of IVF/ICSI-ET. We retrospectively analyzed the clinical data of 31 057 cycles of women with infertility undergoing IVF/ICSI-ET with hysteroscopy and treated at the First Affiliated Hospital of Zhengzhou University Reproductive Medicine Center from August 2009 to May 2018. According to the previous condition of their uterine cavity, patients were divided into the normal uterine cavity, single uterine cavity abnormality, and complex uterine cavity abnormality groups. Differences in general conditions and pregnancy-assisted outcomes were compared among the groups, which were screened according to propensity score matching. In 3005 cycles after propensity score matching screening, there were no statistically significant differences in the implantation and clinical pregnancy rates of patients with successfully treated uterine cavity abnormalities and lesions (p > .05). The miscarriage rate was significantly higher in the complex uterine cavity abnormality group than in the normal (p=.001) and single uterine cavity abnormality groups (p=.002). Logistic regression analysis showed that the female partner's age (adjusted odds ratio, 1.12; 95% confidence interval, 1.05-1.19; p=.001) and history of intrauterine adhesions (adjusted odds ratio, 1.44; 95% confidence interval, 1.12-1.85; p=.005) were independent risk factors for miscarriage. The age of the female partner and history of intrauterine adhesions increased the miscarriage rate in patients undergoing IVF/ICSI-ET.