Semra Eroglu, Eser Colak, Hulusi Bulent Zeyneloglu, Emel Ebru Ozcimen

Detection of intracavitary lesions in 436 infertile women by office hysteroscopy and comparison with histopathology results

Aim: To examine the importance of office hysteroscopy in detecting and treating endometrial pathologies of infertile patient groups. Materials and Methods: For this retrospective observational study, first, electronic hospital records were examined in order to identify patients who underwent office hysterescopy at our clinic, between 2003 and 2020, for infertility. The office hysteroscopy findings of 436 patients were included in the study, and examined and compared with the histopathological results. Results: The age distribution of the patients included in the study was homogeneous in terms of group variances. Thehysteroscopy findings of the patients were as follows: normal cavityin 137 patients(31.4%), endometrial polyps in 199 patients(45.6%), synechia in 14 patients(3.2%), subseptum or arcuate uterus in 32 patients (7.3%), t-shaped uterus in 28 patients (6.4%), cervical polyps in 6 patients (1.4%), Asherman’s syndrome in 6 patients (1.4%), and submucous myoma in 14 patients (3.2%). The most frequently detected lesion with office hysteroscopy was polyps,at a rate of 47% with 205 patients. In the pathology results, of the 137 patients who were diagnosed with normal endometrium via office hysteroscopy and underwent biopsy, 119were reported as normal (89.6%), while 6 were diagnosed with polyps (4.4%). The sensitivity and specificity of office hysteroscopy in detecting endometrial polyps were 94% and 56%, respectively. Conclusion: Office hysteroscopy may be one of the first alternative methods that can be used for safe and practical outpatient diagnosis and treatment in infertile patient groups.

PDF

___

1. Female infertility. In: Fritz MA, Speroff L. Clinical gynecologic endocrinology and infertility. 8 th ed. Philadelphia: Woltres Kluwer Health/Lippincott Williams & wilkins, 2012. p. 1137-90
2. Practice Committee of American Society for Reproductive Medicine.Diagnostic evaluation of the infertile female: a committee opinion. Fertil Steril 2012;98:302-7.
3. Hatasaka H. Clinical management of the uterine factor in infertility. Clin Obstet Gynecol 2011;54:696-709. 4. Taylor E, Gomel V. The uterus and fertility. Fertil Steril 2008;89:1-16.
5. Grimbizis G, Gordts S, Di Spiezio Sardo A, et al. The ESHRE-ESGE consensus on the classification of female genital tract congenital anomalies. Gynecol Surg. 2013;10:199-212.
6. Balić D, Balić A.Office hysteroscopy, transvaginal ultrasound and endometrial histology: a comparison in infertile patients. Acta Medica Academica 2012;40: 34-8.
7. Brown SE, Coddington CC, Schnorr J, et al. Evaluation of outpatient hysteroscopy, saline infusion hysterosonography, and hysterosalpingography in infertile women: a prospective, randomized study. Fertil Steril 2000;74:1029-34.
8. Soares SR, dos ReisMMBB, Camargos AF. Diagnostic accuracy of sonohysterography, transvaginal sonography, and hysterosalpingography in patients with uterine cavity diseases. Fertil Steril 2000;73: 406-11.
9. Amer-Cuenca JJ, Marín-Buck A, Vital SG, et al. Non-pharmacological pain control in outpatient hysteroscopies. Minimally Invasive Therapy & Allied Technologies 2020;29:10-9.
10. Shokeir TA, Shalan HM, El Shafei MM. Significance of endometrial polyps detected hysteroscopically in eumenorrheic infertile women. Aust N Z J Obstet Gynaecol 2004;30:84-9.
11. Vitale SG, Sapia F, Rapisarda AMC, et al. Hysteroscopic morcellation of submucous myomas: a systematic review. BioMed research international. Published online: 2017.
12. O’Flynn, N. Assessment and treatment for people with fertility problems: NICE guideline. British J of General Practice 2014;64:50-1.
13. Mohammed Eloraby N, Elnory MA, Eldeen AAS, et al. Journal homepage: http://www. journalijar. com ınternatıonal journal journal doı: 10.21474/ıjar01 of advanced research research artıcle dıagnostıc hysteroscopy as a prımary tool ın basıc ınfertılıty workup. Int J 2016;4:1716-21.
14. Richlin SS, Ramachandran S, Shanti A, et al. Glycodelin levels in uterine flushings and in plasma of patients with leiomyomas and polyps: implications for implantation. Hum Reprod 2002;17:2742-7.
15. Oehninger S, Coddington CC, Hodgen GD, et al. Factors affecting fertilization: endometrial placental protein 14 reduces the capacity of human spermatozoa to bind to the human zona pellucida. Fertil Steril 1995;63: 377-83.
16. Radwan P, Radwan M, Polać I, et al. Detection of intracavitary lesions in 820 infertile women: comparison of outpatient hysteroscopy with histopathological examination. Ginekol Pol 2013;84: 857-61.
17. Yantapant A. Comparison of the accuracy of transvaginal sonography and hysteroscopy for the diagnosis of endometrial polyps at Rajavithi Hospital. J Med Assoc Thai 2012;95:92-7.
18. Garuti G, Sambruni I, Colonnelli, et al. Accuracy of hysteroscopy in predicting histopathology of endometrium in 1500 women. J Am Assoc Gynecol Laparosc 2001;8:207-13.
19. Lin PC. Reproductive outcomes in women with uterine anomalies. J Womens Health 2004;13:33-9.
20. Kormányos Z, Molnár BG, Pál A. Removal of a residual portion of a uterine septum in women of advanced reproductive age: obstetric outcome. Hum Reprod 2006;21:1047-51.
21. Zolghadri J, Momtahan M, Aminian K, et al. The value of hysteroscopy in diagnosis of chronic endometritis in patients with unexplained recurrent spontaneous abortion. European J Obstetrics & Gynecology and Reproductive Biology 2011;155: 217-20.
22. Johnston-MacAnanny EB, Hartnett J, Engmann LL, et al. Chronic endometritis is a frequent finding in women with recurrent implantation failure after in vitro fertilization. Fertil Steril 2010;93:437-41.
23. Goldenberg M, Sivan E, Sharabi Z, et al. Reproductive outcome following hysteroscopic management of intrauterine septum and adhesions. Hum Reprod 1995;10: 2663-5.
24. Capella-Allouc S, Morsad F, Rongieres-Bertrand C, et al. Hysteroscopic treatment of severe Asherman's syndrome and subsequent fertility. Hum Reprod 1999;14:1230-3.