Sibel Sak, Emin Taşdüzen, Güler Çakmak, Nurullah Peker, Talip Karaçor, Muhammet Erdal Sak

Açıklanamayan İnfertilitesi olan Kadınlarda Ofis Histereskopi:En Sık Saptanan Anormal Histereskopik Bulgular

Amaç: Açıklanamayan primer ve sekonder infertil olan kadınlarda servikal kanal ve uterin kaviteyi ofis histereskopi (H/S) ile değerlendirerek bu hastalardaki intrauterin anormal bulgu sıklığını belirlemektir.Gereç ve yöntem: Bu çalışma Harran Ünüversitesi Üremeye Yardımcı Tedavi Merkezimize Aralık 2016 ve Ekim 2017 tarihleri arasında başvuran açıklanamayan infertilitesi olan ve daha önce ofis histeroskopyi yapılmamış toplam 102 primer ve sekonder infertil hastanın dahil edildiği retrospektif bir çalışmadır. Hastaların yaş,infertilite tipi, infertilite süresi ,vücut kitle indexi (VKİ) komplikasyon ve histereskopik bulguları hasta dosyalarından kaydedildi. Hastalar 20-30, 31-35, 36-40 yaş infertil kadınlar şeklinde 3 gruba ayrıldı. 20 -30 yaş grubu genç yaş, diğer yaş gruplarını ileri yaş grubu olarak kabul edildi. İnfertilite türüne ve yaşa göre en sık anormal histereskopik bulgular saptandı. Ofis histereskopi işlemi deneyimli 3 hekim tarafından gerçekleştirildi.Bulgular: Ofis histereskopi yapılan hastaların 81.37% (83/102) primer infertil, 18.63% (19/102) ü sekonder infertil idi. Açıklanamayan infertilitesi olan kadınlarda 38.2% anormal histereskopik bulgu saptandı. H/S yapılan primer inferil hastaların 60.24% ü(49/82) sekonder inferil hastaların ise 73.68% inde (14/19) herhangi bir histereskopik patolojik bulguya rastlanmadı. Endometrial polip her iki grupta ensık (9.8%( 10/102)) izlenen anormal histereskopik bulgu idi. Uterin septum ise ikinci sıklıkta (8.8% (9/102)) görülen anormal bulgu idi. İleri yaş kadınlarda endometrial polıp ve septum, genç yaş grupta endometrial polip ve inflamasyon ağırlıklı olarak izlendi. Sonuç: Nedeni bilinmeyen infertilite endikasyonu ile histereskopi yapılan hastalarda, yüksek oranda uterin anormallik olduğu tespit edildi. Bu uterin patolojiler uygulanacak infertilite tedavilerinin başarısını düşürebileceğinden bu patolojilerin tanısı önemlidir. Ofis histereskopi hastanın kolay tolere etmesi ve hasta için minimal risk taşımasından dolayı bu hastalarda ideal ilk basamak tanı işlemi olarak kabul edilebilir.

Anahtar Kelimeler:

İnfertilite, histereskopi, anormal uterin bulgular

Office Histeroscopy In Unexplained Infertile Women :The Most Common Abnormal Histeroscopic Findings

Objective: Cervical canal and uterine cavity are evulated by office hysteroscopy (H/S) to determine the intrauterine abnormal findings in unexplained primary and secondary infertile women .Material and method: This study is a retrospective study that included 102 primary and secondary infertile patients with unexplained infertility and who had not previously had office hysteroscopy , applied to infertility and IVF clinic of Harran University Training and Research Hospital between December 2016 and October 2017. Patients' age, infertility type, duration of infertility, body mass index (BMI), complications and hysteroscopic findings were recorded from patient files. Patients were divided into 3 groups of 20-30, 31-35, 36-40 years infertile women. Infertile women between 20 and 30 years of age were accepted as younger age group and other ages were accepted as elder groups. Office hysteroscopy was performed by 3 experienced physicians.Results: 81.37% (83/102) of patients were primary infertile and 18.63% (19/102) were secondary infertile. In women with unexplained infertility, abnormal hysteroscopic findings were found in 38.2%. 60.24% (49/82) of the primary infertile patients and 73.68% (14/19) of the secondary inferitile patients who underwent hysteroscopy did not have any uterine pathological findings. Endometrial polyp was most common abnormal hysteroscopic finding in both groups (9.8% (10/102)). Uterine septum was the second most common finding (8.8% (9/102)). The incidence of endothelial polyp and septum were high in advanced age women, and incidence of endometrial polyp and inflammation were high in young age group. Conclusion: In unexplained infertile patients who underwent histeroscopy , high proportion of uterin abnormalitıes were detected. These abnormalities may impair the success of future ınfertility treatment cycles so diagnosis of these pathologies ıs very important. Office hysteroscopy can be regarded as the ideal first-line diagnostic procedure in these patients due to easy tolerating of the patient and minimal risk for the patient.

Keywords:

Infertility, hysteroscopy, abnormal uterine findings,

PDF

___

1. Practice Committee of tAmerican Society for Reproductive M. Definitions of infertility and recurrent pregnancy loss. Fertility and sterility. 2008;90(5 Suppl):S60. 2. Jahan S. Role of Laparoscopy in Infertility. BIRDEM Medical Journal. 2012;2(2):99-103. 3. Cândido dRF, Nogueira A, Ferriani R. Routine office hysteroscopy in the investigation of infertile couples before assisted reproduction. The Journal of reproductive medicine. 2005;50(7):501-6. 4. Crosignani P, Rubin B. Optimal use of infertility diagnostic tests and treatments. The ESHRE Capri Workshop Group. Human reproduction (Oxford, England). 2000;15(3):723-32. 5. Rowe P, Comhaire F, Hargreave T, Mellows H. WHO manual for the standardized investigation and diagnosis of the infertile couple. Press Syndicate of the University of Cambridge, Cambridge, 1993. 1993. 6. Prevedourakis C, Loutradis D, Kalianidis C, Makris N, Aravantinos D. Surgery: Hysterosalpingography and hysteroscopy in female infertility. Human Reproduction. 1994;9(12):2353-5. 7. Golan A, Eilat E, Ron-el R, Herman A, Soffer Y, Bukovsky I. Hysteroscopy is superior to hysterosalpingography in infertility investigation. Acta obstetricia et gynecologica Scandinavica. 1996;75(7):654-6. 8. Begum J, Samal S, Ghose S, Palai P, Samal R. Combined hysterolaparoscopy as an early option for initial evaluation of female infertility: a retrospective study of 135 patients. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2017;4(3):584-8. 9. Cholkeri-Singh A, Sasaki KJ. Hysteroscopy for infertile women: a review. Journal of minimally invasive gynecology. 2015;22(3):353-62. 10. Kilic Y, Bastu E, Ergun B. Validity and efficacy of office hysteroscopy before in vitro fertilization treatment. Archives of gynecology and obstetrics. 2013;287(3):577-81. 11. Demirol A, Gurgan T. Effect of treatment of intrauterine pathologies with office hysteroscopy in patients with recurrent IVF failure. Reproductive biomedicine online. 2004;8(5):590-4. 12. Campo R, Van Belle Y, Rombauts L, Brosens I, Gordts S. Office mini-hysteroscopy. Human Reproduction Update. 1999;5(1):73-81. 13. Pansky M, Feingold M, Sagi R, Herman A, Schneider D, Halperin R. Diagnostic hysteroscopy as a primary tool in a basic infertility workup. JSLS: Journal of the Society of Laparoendoscopic Surgeons. 2006;10(2):231. 14. Dicker D, Goldman JA, Ashkenazi J, Feldberg D, Dekel A. The value of hysteroscopy in elderly women prior to in vitro fertilization-embryo transfer (IVF-ET): a comparative study. Journal of in vitro Fertilization and Embryo transfer. 1990;7(5):267-70. 15. Shalev J, Meizner I, Bar-Hava I, Dicker D, Mashiach R, Ben-Rafael Z. Predictive value of transvaginal sonography performed before routine diagnostic hysteroscopy for evaluation of infertility. Fertility and sterility. 2000;73(2):412-7. 16. Pérez-Medina T, Bajo-Arenas J, Salazar F, Redondo T, Sanfrutos L, Alvarez P, et al. Endometrial polyps and their implication in the pregnancy rates of patients undergoing intrauterine insemination: a prospective, randomized study. Human Reproduction. 2005;20(6):1632-5. 17. Bosteels J, Kasius J, Weyers S, Broekmans FJ, Mol BWJ, D'Hooghe TM. Hysteroscopy for treating subfertility associated with suspected major uterine cavity abnormalities. The Cochrane Library. 2015. 18. Simón C, Martinez L, Pardo F, Tortajada M, Pellicer A. Müllerian defects in women with normal reproductive outcome. Fertility and sterility. 1991;56(6):1192-3. 19. Homer HA, Li T-C, Cooke ID. The septate uterus: a review of management and reproductive outcome. Fertility and sterility. 2000;73(1):1-14. 20. Zhang E, Zhang Y, Fang L, Li Q, Gu J. Combined hysterolaparoscopy for the diagnosis of female infertility: a retrospective study of 132 patients in china. Materia socio-medica. 2014;26(3):156.