Uterine Cavity Pathologies Research Articles

Hysterosalpingographic Pattern of Primary Sub-fertility and Secondary Sub-fertility in Women of Reproductive Age

Objective: To evaluate the structural abnormalities of uterus and fallopian tubes in women diagnosed with primary and Secondary Sub-fertility using hysterosalpingogram. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, Rawalpindi Pakistan, from Jul to Nov 2019. Methodology: This study investigated potential anatomical causes of primary and secondary subfertility in women of reproductive age. A total of 500 participants, referred from Gynecology and Obstetrics Departments, underwent hysterosalpingography during the pre-proliferative phase following comprehensive medical history assessment. Results: Out 500 women, 340(68.0%) had Primary Sub-fertility while 160(32%) had Secondary Sub-fertility. Mean age of presentation was 31.5±3.5 years. Bilateral free peritoneal spill was recorded in 340(68%) patients. Unilateral tubal blockage was present in 50(10%) patients while bilateral tubal blockage was observed in 40(8.0%) patients. Bilateral hydrosalpinx was present in 15(3 %) women. Patients with uterine congenital anomalies were also examined, and bicornuate uterus was seen in 25(5%) women and unicornuate uterus was noted in the same number, that is, 25(5%) women. Conclusion: Hysterosalpingography is a baseline assessment test done for evaluation of patency of uterus and uterine tubes. Positive hysterosalpingography cases were more prevalent in Secondary Sub-fertility. Tubal abnormalities were more commonly observed as compared to uterine cavity pathologies. Secondary Sub-fertility was found to be more associated with older age groups.

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.

SALINE INFUSION SONOGRAPHY: A VALID TOOL FOR DETECTION OF INTRAUTERINE PATHOLOGY IN WOMEN WITH ABNORMAL UTERINE BLEEDING

ABSTRACT:
 OBJECTIVE:
 To evaluate the diagnostic accuracy of transvaginal ultrasound and saline infusion sonography for the detection of intra-cavity lesions of uterus using histopathology on hysterectomy specimens as the gold standard.
 STUDY DESIGN:
 Cross-sectional (validation) study.
 Place & duration of study:
 Department of obstetrics & gynecology, Madina Teaching Hospital, Faisalabad from January 18, 2022 to September 30, 2022.
 METHODOLOGY:
 Sixty patients with abnormal uterine bleeding and postmenopausal bleeding were included in the study. All participants were evaluated by transvaginal ultrasound (TVS) and saline infusion sonography (SIS) to detect uterine cavity pathologies. The findings at TVS and SIS were compared with the findings of histopathology on hysterectomy specimens. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were calculated.
 RESULTS:
 Mean age was 49.68±5.9 years. Polyps, proliferative endometrium, endometrial hyperplasia and sub mucous fibroid are noted in 32 (53.3%), 16 (26.7%), 3 (5%) and 9 (15%) patients, Sensitivity, specificity, PPV, NPV and diagnostic accuracy of TVS are 61.36%, 100%, 100%, 48.48% and 71.67% and for SIS are 88.64%, 100%, 100%, 76.19% and 91.67% respectively.
 CONCLUSION:
 SIS is highly sensitive and specific investigation to detect intra-cavity abnormalities of uterus. SIS can be used as an alternative investigation tool in low resource settings whenever hysteroscopy in not readily available.
 KEY WORDS: Uterine cavity lesions, sensitivity, specificity, saline infusion sonography
 

ASSESSING THE EFFICACY OF LONG-PROTOCOL OVULATION STIMULATION USING GONADOTROPIN-RELEASING HORMONE AGONIST IN WOMEN EXPERIENCING INFERTILITY AND COMORBIDITY OF LEIOMYOMA AND CHRONIC ENDOMETRITIS

Introduction. Nowadays infertility is one of the global medical and social issues worldwide. Assisted reproductive technologies, including in vitro fertilization, is one of the main techniques for restoring fertility. Among the main stages of IVF are controlled ovarian stimulation (COS), the optimal method of which is chosen depending on a numerous factor, such as the patient's age, the ovarian reserve, and the presence of concomitant gynecological or extragenital pathology. The prevalence of various combinations of gynecological pathologies, for example, the comorbidity of uterine leiomyoma and chronic endometritis, can affect the results of IVF in different ways, so scientists around the world are increasingly studying the management of such patients. The aim of the study is to compare controlled ovarian stimulation long-protocol parameters and its effectiveness in the therapy of infertile patients with the comorbidity of uterine leiomyoma and chronic endometritis. Methods and participants. We performed retrospective comparative analysis of anamnestic data of 130 women with infertility who underwent infertility treatment with assisted reproductive technologies. The patients were divided into three groups. In all groups, stimulation of superovulation was carried out following a long protocol with a GnRH agonist; p<0.05 was considered statistically significant during the statistical data processing. Results. The study has revealed that higher starting dose of gonadotropins, as well as higher total gonadotropin consumptions are required for the patients of the second study group with uterine leiomyoma and chronic endometritis, compared to the first study group and the control group. The number of retrieved oocytes, including mature ones, were the lowest as well as the number of immature, deeply immature and degenerative oocytes were the highest in the second study group. The lowest rate of normal fertilization (2pn) and, as a result, a lower blastocyst yield is recorded in the same group. The highest frequency of aborted pregnancies among achieved clinical pregnancies is observed in the group of infertile women with uterine leiomyoma and chronic endometritis. Conclusions. The presence of the uterine cavity pathology combined with persistent chronic inflammation of the uterine mucosa, as well as the absence of proper preparation for IVF-ET cycles are the main reasons for the negative infertility treatment outcomes in such patients. This justifies the need for appropriate optimal preparation and elimination of the identified negative factors before or during the infertility treatment.

Contribution of the uterine cavity microbiota to the development of pathological endometrial processes

Introduction. In the structure of gynecological morbidity intrauterine pathology occupies a leading position because of its high frequency and negative impact on the reproductive health of a woman. Endometrial pathology is numerous and includes endometrial hyperplasia and polyps, endometrial cancer, abnormal uterine bleeding and dysmenorrhea, endometriosis and Asherman's syndrome. Pathological changes of the endometrium in women with reproductive problems, such as infertility, habitual miscarriage, are particularly relevant.The aim of the work is to estimate the contribution of endometrial microbiota in the development of endometrial pathological processes and identify possible pathogens for the development of this process on the basis of scientific literature data.Materials and methods. Data analysis and systematization were performed on the basis of scientific publications in the PubMed, Google scholar, and Scopus databases for the period 2010–2021. For the final scientific review 65 sources were selected.Results and discussion. This article presents findings on the role of the uterine cavity microbiota and its contribution to endometrial pathology such as endometrial polyps and hyperplasia, adenomyosis and uterine bleeding, infertility and intrauterine synechiae. The correction of an altered microbiota opens up new insights into the development of uterine diseases and new therapeutic options.Conclusion. Numerous studies of the uterine cavity microbiota show its undoubted role in the development of uterine cavity pathology. However, the data obtained are quite contradictory. Further study of the uterine microbiota is necessary for a deeper understanding of the pathogenesis of endometrial pathological processes.

Role of 3D Ultrasonography and Hysteroscpy in Detecting Uterine Cavity Pathologies

valuation of Uterine cavity can be done using Hysterosalpingography (HSG), Trans Vaginal Ultrasonography (TVS), Sonohysterography (SHG) and Hysteroscopy. Uterine cavity abnormalities, e.g., endometrial polyps, submucous myomas, intra- uterine adhesions, endometritis and uterine septum may result in Abnormal Uterine Bleeding (AUB) in the form of menorrhagia or metrorrhagiaor or failure to conceive.

Sonohysterography Versus Hystroscopy In Evaluation Of Uterine Cavity Pathology

BACKGROUND: Intrauterine pathologies are the underlying causes of infertility in about 15% of infertile women. Multiple uterine abnormalities may interfere with implantation and can cause spontaneous abortion, such as uterine septum, intrauterine adhesions, endometrial polyps or submucous myomas. Variable diagnostic modalities including hysterosalpingography, transvaginal ultrasound, sonohysterography and hysteroscopy can be used to assess the uterine cavity. The purpose of our study is to evaluate the importance of sonohysterography in correlation with vaginal hysteroscopy in evaluating uterine cavity pathology.Methods: This prospective cross-sectional study was performed on 48 women suspected of having an intrauterine abnormality. Between days 7 and 10 of the menstrual cycle, sonohysterography was done. In the mid proliferative phase of the menstrual cycle for premenopausal women, hyteroscopy was done. Histopathology was our gold standard reference.Results: The results of sonohysterography and hysteroscopy have been compared with histopathology. We observed that sonohysterography showed 26.7 percent of cases as normal and 73.3% had abnormal finding in form of endometrial polyp 30.3%, increased endometrial thickness 30.3%, submucous leiomyoma 24.3% and intra-uterine septum 15.1%, while hystroscopic findings showed 13.3 percent of cases as normal and 86.7% had abnormal finding in form of endometrial polyp 26.7%, increased endometrial thickness 17.8%, submucous leiomyoma 20.0%, intra-uterine adhesion 13.3% and intra-uterine septum 8.9%.Conclusions: Sonohysterography is an integral examination procedure in the study of uterine cavity pathology; so it can be provided as a first-line diagnostic modality for uterine abnormality assessment; eliminating the costly need for hysteroscopy which considered more discomfort to women concerned.

Diagnostic yield and therapeutic outcome of hysteroscopy in women with infertility in a referral clinical setting: a Port Harcourt, Nigeria experience.

Introductionintrauterine pathologies were traditionally evaluated by blind dilatation and curettage along with hysterosalpingography. Hysteroscopy is a veritable tool for evaluation of uterine cavity pathologies with an increasing availability in Nigeria. The study aims to report the diagnostic yield and therapeutic outcome of hysteroscopy in women with infertility from a Nigerian metropolis.Methodsa retrospective cross-sectional study of consecutive cases of infertile women referred for hysteroscopy to an ambulatory care endoscopy facility in Port Harcourt, Nigeria. The variables collated included age, parity, past gynaecological history, indication, hysteroscopy findings and interventions. Statistical analysis was performed using SPSS version 25.Resultsincluded in study were 75 patients undergoing a total of 124 hysteroscopic procedures. The age range of patients was 25 to 56 years (mean 40.7 ± 5.9 years). A positive diagnostic yield of 93.3% with non-visualization of intracavitary uterine pathology in 5 patients was recorded. The most common pathologies were submucous myoma-25(31.3%), endometrial polyps- 18(22.5%) and intrauterine adhesions-18(22.5%). There was no statistical difference between the mean age of patients with or without polyp, myoma and intrauterine adhesions (P = 0.185, P = 0.510 and P = 0.619 respectively) but a non-linear relationship between age and polyp detection (Eta2 = 0.024). Operative hysteroscopies were all performed on out- patient basis but staged in 30(40.0%) patients.Conclusionbenign uterine growths and intrauterine adhesions are frequent causes of uterine factor infertility. A high successful completion rate of hysteroscopic interventions was achieved.

Hysteroscopic and morphological assessment of intrauterine pathology in different age periods

The pathology of the endo- and myometrium takes the main place in the structure of gynecological diseases. The introduction of endoscopic technologies has expanded the diagnostic capabilities of the study of intrauterine pathology. The morphological method is the gold standard in diagnosing the uterine cavity pathology. A retrospective analysis of 100 video protocols of hysteroscopy and morphological data obtained in Vash Doctor Clinic Ltd., Simferopol over the year 2018 was performed. During a retrospective analysis of hysteroscopic pictures and pathomorphological findings, all patients were divided into three age groups: (I) 2535 years old (35 women); (II) 3645 years old (35 women); and (III) 4655 years old (30 women). In the early reproductive period, endometrial hyperplasia without atypia prevailed, chronic endometritis prevailing in the late reproductive period, and polyps of the uterus in the period of the menopausal transition and postmenopause.

Hysteroscopy versus transvaginal ultrasound in infertile women prior to intracytoplasmic sperm injection

Objective The aim of this study was to compare the efficacy of transvaginal sonography (TVS) and hysteroscopy regarding the diagnosis of uterine cavity pathologies in a population of infertile women. Background The presence of uterine pathology may negatively affect the chance of implantation. Patients and methods A cross-sectional study at the Department of Obstetrics and Gynaecology at Menoufia University Hospital between March 2018 and March 2019 on 60 women who underwent TVS in the early follicular phase for detection of any uterine cavity abnormalities, followed by diagnostic hysteroscopy for all cases. Results The study included 60 women in the age range of 20–39 years. All cases were divided into two groups, women who were scheduled for first-time in-vitro fertilization (number 52) and women for recurrent in-vitro fertilization (number 8). The cases of primary infertility constituted 46.6% of all participants and 53.3% of cases were of secondary infertility. The abnormal uterine cavity was detected in about 25% of cases evaluated by TVS versus 45% of cases evaluated by hysteroscopy. Using hysteroscopy the most common uterine pathology was endometrial polyp which constituted 18.3% of all cases. TVS missed the diagnosis of 12 cases, three cases of polyps, two case of submucous fibroids, five cases of intrauterine septum, and two cases of intrauterine adhesions in comparison with diagnostic hysteroscopy. Conclusion Diagnostic hysteroscopy is superior to TVS in the diagnosis of intrauterine pathology. Office hysteroscopy takes little time comparable to TVS with little or no complications in experienced skilled hands. TVS has many screening parameters in the detection of polyps and submucous fibroids.

Comparison of Virtual Ultrasonographic Hysteroscopy with Conventional Hysteroscopy in the Workup of Patients Who Are Infertile

Study ObjectiveTo compare the tolerability and diagnostic accuracy of virtual ultrasonographic hysteroscopy (VUH) with that of conventional diagnostic outpatient hysteroscopy in the workup of patients who are infertile. DesignA single-center, retrospective cohort study. SettingDepartment of Obstetrics and Gynecology, Gynecologic Oncology, and Minimally Invasive Pelvic Surgery Unit of Sacred Heart Hospital Don Calabria in Negrar, Italy. PatientsA total of 120 consecutive women who underwent hysterosalpingosonography and subsequent VUH and conventional hysteroscopy for infertility evaluation were included. The inclusion criterion was infertility for at least 1 year, with evaluation in the early or intermediate follicular phase of the menstrual cycle. InterventionsAfter the placement of an intracervical catheter, a Ringer Lactate solution was injected into the uterine cavity and fallopian tubes, and a 3D volume was obtained. The ultrasound volume acquired was successively elaborated offline, and a VUH was performed. Subsequently, a variable amount of air was introduced into the uterine cavity, and the patency of the salpinges was evaluated. Measurements and Main ResultsThe VUH findings were compared with those of conventional hysteroscopy performed in the subsequent month. For the detection of endometrial pathology in the overall pool, the sensitivity and specificity of VUH in comparison with conventional hysteroscopy were 100% (95% confidence interval [CI], 84.6%–100%) and 100% (95% CI, 96.3%–100%), respectively. For the detection of uterine cavity pathology and uterine malformations in the overall pool, the sensitivities of VUH were 80% (95% CI, 28.4%–99.5%) and 100% (95% CI, 75.3%–100%), respectively, with specificities of 100% (95% CI, 96.8%–100%) and 100% (95% CI, 96.6%–100%), respectively, when compared with conventional hysteroscopy. The positive predictive values for endometrial pathology, uterine cavity alterations, and uterine malformations were 100% (95% CI, 84.6%–100%), 100% (95% CI, 39.8%–100%), and 100% (95% CI, 75.3%–100%), respectively, with a receiver operating characteristic area of 100%, 90% (95% CI, 70%–100%), and 100%, respectively. There were no cases of severe vasovagal reactions or other complications. Most patients (67%, 81 of 120 women) described the examination as “less painful than expected,” 25% (30 of 120 women) “just as expected,” and only 7% (9 of 120 women) as “more painful than expected.” ConclusionVUH was well tolerated and showed a high accuracy (100%) in the study of the uterine cavity when compared with conventional hysteroscopy.

The Prevalence and Pattern of Abnormal Hysteroscopy Findings among Subfer-tile Patients at Albayda Fertility Centre/Libya

To estimate the prevalence and types of intrauterine abnormalities in subfertile women: a prospective study was carried out at Albayda Fertility Teaching Centre-Libya. The study was conducted on 115 infertile women attending Albayda Fertility Centre between January and May 2019. Diagnostic hysteroscopy was conducted after initial basic infertility assessment workup to assess the presence and types of uterine cavity pathologies. The duration of infertility ranged from 1-17 years, and the majority of the patients were presented with primary infertility (62.6%), 64.3% of the women had abnormal findings, and the most common lesion detected was endometrial polyp representing 44.6% of the lesions, followed by endometritis 17.6%. Seven cases had septum, and 20 patients had more than one pathology. Corrective measures were taken accordingly. 6.1% of the patients had a spontaneous pregnancy within three months of follow up. The prevalence of abnormal hysteroscopy findings among the studied population was high. Intrauterine endometrial polyps, endometritis, and uterine septum were the most frequent abnormality detected. These findings may indicate a need to incorporate hysteroscopy in the routine evaluation of infertility.

Hysteroscopic tissue removal system (MyoSure) for the resection of polyps, sub-mucosal leiomyomas and retained products of conception in an out-patient setting: A single UK institution experience

PurposeThe present study aimed to elucidate the hysteroscopic tissue removal system (MyoSure) efficacy and safety amongst uterine cavity pathologies (UCPs), and to determine its feasibility in an outpatient setting. We also sought to identify possible factors that could adversely affect complete lesion excision. Methods124 women underwent MyoSure procedure and 135 UCPs were excised, between January 2017 and January 2018. The MyoSure efficacy was evaluated, and potential factors correlated with increased incomplete excision rate were assessed, using both univariate and multivariate analysis. ResultsThe overall MyoSure excision rate was 94.8%. 107/109 polyps and 14/19 leiomyomas were completely resected with a success rate of 98.1% and 73.7% respectively. The complete excision rate amongst retained products of conception (RPOC) cases was 100%. A significant correlation between leiomyomas and incomplete excision was found when compared to polyps and RPOC (p < 0.001). In this cohort, type II leiomyomas (OR = 1.8, p = 0.01) and maximal diameter > 4 cm (OR = 1.6, p = 0.02) were independently correlated with incomplete leiomyomas excision. Nine out of 124 women (7.3%) experienced severe pain during the procedure, while 17% and 73% reported moderate and mild pain respectively. Furthermore, 99% of women (123/124) would undergo the procedure again in the future or recommend it to a friend, for a similar pathology removal. ConclusionsMyoSure is an efficient, safe and feasible operative hysteroscopic procedure in an office-outpatient setting. It is associated with high patient acceptability and, it is highly recommended by the vast majority of the women. Large, and type II leiomyomas are seemingly procedure limitations.

Comparison between 3D-Transvaginal Ultrasound and Hysteroscopy in Detecting Uterine Cavity Abnormalities

Background: unsuspected uterine cavity abnormalities, such as endometrial polyps, small submucous myomas, adhesions, and uterine septum may cause different gynecological complaints such as bleeding and negatively impact chances of success in ART by interfering with implantation or causing spontaneous abortion. Therefore, exclusion of intrauterine pathology is an important step before starting ART and treatment of any discovered lesion may improve ART outcome. The uterine cavity can be evaluated by hysterosalpingography (HSG), transvaginal ultrasound (TVS), sonohysterography (SHG), and hysteroscopy. Hysteroscopy is the gold standard for investi-gation of the uterine cavity, particularly when pathology is suspected. Objective: to assess diagnostic accuracy of three dimensional transvaginal ultrasound (3D-TVS) compared with hysteroscopy in detecting uterine cavity abnormalities. Study design: this prospective observational cross-sectional study was conducted during the January 2018 to June 2018. One hundred women with different uterine pathologies were enrolled. In the mid to late follicular phase of each subject’s menstrual cycle, three D transvaginal ultrasound and hysteroscopy were performed in each patient. Hysteroscopy is widely considered to be the gold standard method for investigation of the uterine cavity. Uterine cavity characteristics and abnormalities were recorded. Diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratios were evaluated. Results: hysteroscopy was successfully performed in all subjects. Hysteroscopy diagnosed pathological findings in 100 of 100 cases (100%). There were 50 endometrial polyps, 13 submucous myomas, 29 septate uterus, and 8 intrauterine adhesions. Three-dimensional transvaginal ultrasound in comparison with hysteroscopy had 85% diagnostic accuracy, 68.2% sensitivity, 91.5% specificity, 79% positive predictive value, and 86% negative predictive value. The positive and negative likelihood ratios were 8.01 and 0.3, respectively. 3D-TVS successfully detected every case of submucous myoma. For detection of endometrial polyps, 3D-TVS had 80.0% sensitivity, 100.0% specificity, and 90% diagnostic accuracy. For detection of septate uterus, 3D-TVS had 93.10% sensitivity, 100.0% specificity, and 98% diagnostic accuracy. Conclusion: three D-TVS demonstrated 84.1% diagnostic accuracy for detecting uterine cavity abnormalities in infertile women. A significant percentage of patients had evidence of uterine cavity pathology. Hysteroscopy is, therefore, recommended for accurate detection and diagnosis of uterine cavity lesion.

Evaluation of Uterine Cavity in Infertile Women: Comparison of Transvaginal Ultrasound, Saline Contrast Hystero-Sonography and Hysteroscopy—A Tunisian Series

The development of uterine pathologies usually involves transvaginal ultrasonography, possibly supplemented by hysteroscopy. Recent technical developments in ultrasound have given rise to a new exploration technique: hysterosonography or ultrasound with contrast enhancement. Hysterosonography has emerged today in the study of the uterine cavity with a precise analysis of the endometrial mucosa and related pathologies. Objectives: To determine the contribution of hysterosonography in uterine cavity pathologies, and appraise the performance of this examination in the evaluation of the uterine cavity by comparing it to vaginal ultrasound and diagnostic hysteroscopy. A retrospective study of 39 hysterosonography examinations was performed in the Gynecology and Obstetrics Department of Farhat Hached University Hospital Center, Sousse, Tunisia. Included in the study were patients suffering from infertility. During the period of the clinical trial, 39 patients were potential candidates for this study. The mean age of the patients was 31.5 years. In case of hypofertility associated with endometrial polyps, the hysterosonography/histology concordance was of 51.4% (13/24). The statistical values of the hysterosonography were: sensitivity: 76.9%, specificity: 27.2%, VPP: 55.5%, and VPN: 50%. In case of uterine malformation, hysterosonography allowed the diagnosis to be made in three cases, with a sensitivity of 100%, but the number of these abnormalities was limited and the statistical value was low. In clinical practice, combining hysterosonography with transvaginal ultrasound may increase the sensitivity of the latter, thus avoiding unnecessary diagnostic hysteroscopies. It is likely to significantly reduce the indications for diagnostic hysteroscopy, a test that is not devoid of morbidity.

110 - Combined Use of Office Hysteroscopy and Hysterosalpingography: A Novel Combination in Infertility Work-Up

Study Objective: In patients who have planned hysterosalpingography (hsg) for routine infertility workup, investigate the feasibility and potential benefits of simultaneous office hysteroscopy (ofhys) use. Design: Prospective, clinical study. Setting: Tertiary care center affiliated with a school of medicine. Patients: 72 infertile patients were selected for this study. There were no endometrial or adnexal pathology during the initial ultrasound examination. An environment was established for simultaneous use of ofhys and hsg under portable fluoroscopy. Mild sedation or parentheral analgesics were used during the procedure according to the patient's need. Intervention: The ofhys procedure started from introduction of the 4 mm rigid ofhys (Karl Storz, Germany) through the external cervical os, and finished after visualization of the uterine cavity and tubal ostia. If any pathology is detected, appropriate surgical procedure (adhesiolysis, polypectomy, etc.) was carried out with the help of scissors or grasper which passed through the operative channel of ofhys. Before removing the hysteroscope the portable fluoroscopy was adjusted for an appropriate pelvic image, and a hsg was performed by applying contrast media through an irrigation cannula. We recorded the procedural time, and the findings of the combined ofhys and hsg. Measurements and Main Results: While evaluating the combined ofhys-hsg, normal findings were found in 47 patients and pathological findings were found in 25 patients. Procedural time was statistically higher in patients who detected abnormal findings (2.55 ± 1.06 vs 6.82 ± 4.2 minutes respectively, p: .001). Tubal pathology detection rate was 15.3% for hsg. The rate of endometrial pathology detected and corrected during ofhys was 25%.Table 1Combined office hysteroscopy-hysterosalpingoraphy (ofhys-hsg) findingsofhysFrequencyPercentNormal5475Endometritis11.4Polyp1318Synechia34.2Endometrial hyperplasia11.4Total72100hsgFrequencyPercentNormal6184.7Bilateral prox. tubal obst.22.8Unilateral prox. tubal obst811.1Unilat. hydrosalpenks11.4Total72100ofhys: Office hysteroscopy, hsg: Hysterosalpingography. Open table in a new tab ofhys: Office hysteroscopy, hsg: Hysterosalpingography. Conclusion: The combined ofhys-hsg method is not only more reliable for the assessment of tubal and uterine cavity pathologies, but also give an opportunity to treat endometrial pathologies are detected at the same time. Safety, ease of use, shortened time of pre-treatment research of infertility and high patient tolerance may make combined ofhys-hsg method an ideal candidate for the infertility workup.

The role of Hysterosalpingo-contrast sonography in the evaluation of tubal patency and uterine cavity pathology in infertile women

The role of Hysterosalpingo-contrast sonography in the evaluation of tubal patency and uterine cavity pathology in infertile women

A Comparative Observational Study of the Use Transvaginal Ultrasound and Hysteroscopy for the Detection of Uterine Cavity Pathologies in Women with Abnormal Uterine Bleeding

Background: 70% of all gynecological consultations are for abnormal uterine bleeding. Any approach to optimal management begins with an appropriate diagnosis. 40% of premenopausal women with abnormal uterine bleeding were found to have some intrauterine pathology. This study aims to compare the diagnostic value of transvaginal ultrasonography in comparison to hysteroscopy in detecting uterine abnormalities in patients with abnormal uterine bleeding. Methods: Retrospective observational cross sectional study of 250 women presented with abnormal uterine bleeding. The patients who fulfilled the selection criteria and have been sequentially investigated by transvaginal ultrasound (TVS) and hysteroscopy were included. Results: 90% of patients were from 35 - 49 yrs. 81.2% of patients have body mass index above 25 kg/m2. Transvaginal ultrasound (TVS) compared well with high sensitivity as regards normal endometrium. (TVS) missed 4 patients of endometrial polyps and one patient of sub mucous fibroid. Three patients of adenomyosis were only diagnosed by (TVS); they were reported as being normal by hysteroscopy. Conclusion: (TVS) is considered as an excellent approach to the initial evaluation of uterine pathologies in patients with abnormal uterine bleeding.

Saline infusion sonography versus hysteroscopy in the evaluation of uterine cavity in women with unexplained infertility

Background Uterine abnormalities, congenital or acquired, are implicated as one of the causes of infertility. Embryo implantation depends on the quality of the ovum, the condition of the endometrium as well as the uterine cavity. Hence, it is recommended to diagnose and treat these abnormalities in patients with unexplained infertility. Objective The aim of this study was to compare the diagnostic accuracy between saline infusion sonography (SIS) and hysteroscopy (HS) to evaluate uterine cavity pathologies among women with unexplained infertility. Patients and methods This study was carried out on 50 women with unexplained infertility in the Department of Obstetrics and Gynecology at Tanta University Hospital, from March 2015 to December 2015. Patients were subjected to an ultrasound assessment of uterine cavity using saline as the contrast medium (SIS) and then followed by HS on a later date. Examination was performed after cessation of menstruation, but before the 10th day of the menstrual cycle (early-proliferative phase of the same menstrual cycle). The uterine cavity was inspected for irregularities such as synechiae, polyps, and submucous myomas, as well as uterine malformations. Sensitivity, specificity, accuracy, and positive and negative predictive values of SIS and diagnostic HS to detect intracavitary abnormalities were compared. Results In this study, HS was more sensitive (100 vs. 85%), with the same specificity (100 vs. 100%), and more accurate (100 vs. 94%) than SIS. HS also had a higher predictive value (100 vs. 100% positive predictive value, 100 vs. 90% negative predictive value) than SIS during the evaluation of patients with unexplained infertility. Conclusion Infertile women should be screened for possible uterine cavity abnormalities. HS is still considered the gold standard to diagnose intrauterine pathology as it is more sensitive and more accurate than SIS. However, SIS has the advantages of being a simple, well-tolerated, noninvasive, cheap, affordable, shorter duration, and accurate method for uterine cavity evaluation. Thus, SIS can be used as an alternative technique for the evaluation of uterine cavity abnormalities when HS is not available.

Diagnostic accuracy of 3D-transvaginal ultrasound in detecting uterine cavity abnormalities in infertile patients as compared with hysteroscopy

ObjectiveTo assess diagnostic accuracy of 3D transvaginal ultrasound (3D-TVS) compared with hysteroscopy in detecting uterine cavity abnormalities in infertile women. Study designThis prospective observational cross-sectional study was conducted during the July 2013 to December 2013 study period. Sixty-nine women with infertility were enrolled. In the mid to late follicular phase of each subject's menstrual cycle, 3D transvaginal ultrasound and hysteroscopy were performed on the same day in each patient. Hysteroscopy is widely considered to be the gold standard method for investigation of the uterine cavity. Uterine cavity characteristics and abnormalities were recorded. Diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratios were evaluated. ResultsHysteroscopy was successfully performed in all subjects. Hysteroscopy diagnosed pathological findings in 22 of 69 cases (31.8%). There were 18 endometrial polyps, 3 submucous myomas, and 1 septate uterus. Three-dimensional transvaginal ultrasound in comparison with hysteroscopy had 84.1% diagnostic accuracy, 68.2% sensitivity, 91.5% specificity, 79% positive predictive value, and 86% negative predictive value. The positive and negative likelihood ratios were 8.01 and 0.3, respectively. 3D-TVS successfully detected every case of submucous myoma and uterine anomaly. For detection of endometrial polyps, 3D-TVS had 61.1% sensitivity, 91.5% specificity, and 83.1% diagnostic accuracy. Conclusion3D-TVS demonstrated 84.1% diagnostic accuracy for detecting uterine cavity abnormalities in infertile women. A significant percentage of infertile patients had evidence of uterine cavity pathology. Hysteroscopy is, therefore, recommended for accurate detection and diagnosis of uterine cavity lesion.