Office hysteroscopy: a review

With the invention of new techniques and modalities “see and treat” has become the norm of management now a days. Diagnostic hysteroscopy combined with histological examination of an endometrial biopsy is considered the ‘gold standard’ in the diagnosis of intrauterine abnormalities. The importance of office hysteroscopy lies in the fact that there is no need of any anesthesia and after the procedure the patient can return into his routine activity only with the minimal aid of NSAIDs. Two different types of hysteroscopes are used worldwide: flexible or rigid, which are made in different sizes. Optic miniaturization has been one of the greatest technological advancements in the field of hysteroscopy, both for rod-lens and fiberoptic scopes. The main concerns in office hysteroscopy are the need for necessary expertise, pain management and management of the complications in the office setting and the high cost of the equipment needed for the procedure. But office hysteroscopy has already demonstrated good correlation of findings compared with inpatient hysteroscopy, providing distinct advantages such as reduced anesthesia risks, enhanced time and cost-effectiveness, and faster recovery with less time away from work and home.

Evaluation of HSG and SIS Diagnostic Value in Comparison to Hysteroscopy to Detect Intrauterine Abnormalities in Infertile Women in Iran

Objective: Hysteroscopy is the gold standard in evaluation of uterine cavity. However, being invasive and its possible adverse effects have reduced popularity of hysteroscopy and clinicians have always been looking for a valid alternative for hysteroscopy. In the current study, we aimed to compare diagnostic value of Saline induced Sonography with HSG in diagnosis of intrauterine abnormalities. Material and Method: We performed a retrospective study on 81 infertile women who underwent hysteroscopy, SIS, and HSG at Taleghani infertility center during their IVF treatment course. Polyp, fibroids, adhesion and septate uterus were considered as abnormality. We reported agreement percent, Kappa, sensitivity, specificity, Area Under Curve, Diagnostic Odds Ratio, Positive Predictive Value, and Negative Predictive value for both SIS and HSG. Results: Total agreement between SIS and hysteroscopy was 85.1, while it was 23.4 for HSG. We also observed considerably higher Kappa for SIS (80.1%) than HSG (15.5%). Overall sensitivity and specificity of SIS for diagnosis of all type of anomaly including both uterine abnormalities and Acquired uterine pathologies was 90.1% (95% CI= 80.7, 95.9) and 90.0% (95% CI= 55.5, 99.7). Meanwhile overall sensitivity and specificity of Hysterosalpingography where hysteroscopy was considered as the gold standard was 54.9 (42.7, 66.8) and 50.0 (18.7, 81.3). Conclusion: SIS is more sensitive tools than HSG for diagnosis of intrauterine abnormalities and could be considered one of the best alternative of hysteroscopy. It provides more accurate detail diagnostic information with high sensitivity and specificity.

Diagnostic Hysteroscopy in Abnormal Uterine Bleeding: A Prospective Analytical study

Localized lesions like a polyp or abnormal growth can be missed by traditional dilatation and curettage whereas such intrauterine abnormalities can be easily diagnosed by hysteroscopy as we can directly visualise the cervical canal and uterine cavity. The objective of our study was to assess the diagnostic accuracy of hysteroscopy in diagnosing the cause of AUB and to correlate hysteroscopy findings with histopathology. This prospective study was conducted in women with symptoms of AUB in the reproductive, perimenopausal and postmenopausal age group who had underwent hysteroscopy over a period of 2 years. Hysteroscopic findings and histopathology findings were compared. The main symptoms for which hysteroscopy was performed was postmenopausal bleeding (44.1%) followed by menorrhagia (33.8%). Hysteroscopy detection of abnormal findings had a sensitivity 90%, specificity 87.5%, positive predictive value 98.2% and negative predictive value 53.8%. To conclude hysteroscopy improves the accuracy of diagnosing intrauterine pathologies and also helps in treating some causes of AUB by simple procedures in the same sitting thereby avoiding major surgeries.

Results of vitamin and mineral complexes’ use during pregnancy (literature review)

The purpose of this review was to study the effect of the intake of vitamin and mineral complexes (VMC) by pregnant women on obstetric and perinatal outcomes. To carry out the analysis, a search was carried out in foreign and domestic publications in the international citation system PubMed, published over the past 15 years. The results of the analysis showed that the use of VMC within 3 months before conception and during pregnancy reduces the risks of intrauterine abnormalities and improves the prognosis of postnatal development of offspring. In addition, taking VMC during gestation reduces the incidence of iron deficiency anemia in pregnant women, intrahepatic cholestasis of pregnant women, preeclampsia, macrosomia, low birth weight, premature birth and postpartum hemorrhage. The use of multicomponent VMC has advantages over taking only folic acid and iron. Conclusion. Taking an VMC during pregnancy can significantly reduce the risk of adverse obstetric and perinatal outcomes. The use of complex drugs is especially important at the stage of preconception and early pregnancy, but it is advisable to continue until the end of pregnancy and lactation.

Hysteroscopic polypectomy versus expectant management in endometrial polyps in asymptomatic infertile women: a meta-analysis

Background: Endometrial polyp is a hyperplastic structural abnormality of the uterine cavity and is one of the most commonly found intrauterine abnormalities. The endometrial polyp is mostly asymptomatic and sometimes diagnosed only during infertility investigation. The influence of endometrial polyps on female infertility is not completely understood, however, due to the possibility of endometrial polyps influencing fertility, their removal is usually performed in women undergoing infertility treatment.Methods: This meta-analysis was performed through an electronic search using MEDLINE, PubMed in October 2017, bringing together the terms of interest in order to select studies that would compare polypectomy and expectant management for endometrial polyps in sub fertile women. Four articles were selected according to the inclusion and non-inclusion criteria.Results: Five variables were collected from the selected articles to be compiled and analyzed (rate of live births per transferred embryo, chemical pregnancy rate, spontaneous abortion rate, implantation rate and clinical pregnancy rate), none of which showed any difference statistically significant in conduct.Conclusions: The data concluded that there is no statistical significance between expectant management and polypectomy.

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.

Role of routine hysteroscopy in previous failed ICSI: a continuous clinical dilemma

Background The benefit of hysteroscopy could extend beyond the treatment of intrauterine abnormalities. Irrigation of the cavity with saline may have a beneficial effect on implantation and pregnancy rates, since saline mechanically washes harmful anti-adhesive glycoprotein molecules on the endometrial surface involved in endometrial receptivity, i.e., cyclooxygenase-2 (COX-2), mucin-1 (MUC-1), and integrin. Objective The aim of this study is to evaluate the role and benefit of routine hysteroscopy prior to ICSI in women with previous failed ICSI. Patients and methods This prospective study has been carried out, at the outpatient clinic, on 100 women that have undergone hysteroscopy as a part of the infertility workup. Women were categorized into three groups according to the number of previous failed IVF/ICSI, once (n = 37), twice (n = 33), and thrice (n = 30). Results After analyzing the data, we found that hysteroscopy was associated with 39% overall clinical pregnancy rate in women with previous/repeat IVF/ICSI failure. Treatment of polyp was associated with 58.3% clinical pregnancy rate (NNT = 1.71). Treatment of intrauterine adhesions was associated with 16.7% clinical pregnancy rate (NNT = 6). Treatment of submucous myoma and uterine septum showed a 75% and 50% clinical pregnancy rate, respectively. Conclusion Hysteroscopic examination in women with previous failed ICSI may improve pregnancy rate even in the absence of uterine pathology. Consequently, hysteroscopy examination may be proposed as a routine step prior to ICSI in case of previous failure.

Role of hysteroscopy for diagnosis and treatment of uterine factors affecting subfertility

Background: Hysteroscopy has become the gold standard for diagnosis of intrauterine abnormalities. Intrauterine lesions such as adhesions, uterine septum polyps or submucous myomas are diagnosed much more precisely by hysteroscopy and are detectable in 10-15% of women seeking treatment for subfertility. The present study analyses various etiological factors in infertility diagnosed by hysteroscopy and to evaluate therapeutic interventions done during hysteroscopy.Methods: The cases for the study will include all women with primary or secondary infertility admitted in tertiary health centre from April 2016 to May 2018 for hysteroscopy.Results: Out of 90 subjects 66 (73.3%) were primary infertility and 24 (26.7%) were secondary infertility. Out of 90 cases studied, 68 (75.6%) had normal findings, 10 (11.1%) had endometrial polyps, 01 (1.1%) had submucous fibroid, 5 (5.6%) had septate uterus, hyperplastic endometrium in 3 (3.3%) and atropic endometrium in 1 (1.1%), intrauterine adhesions and hypoplastic uterus in 1 each. Hysteroscopic interventions were performed in the form of curettage in 08 (33.3%), hysteroscopic cannulation in 2 (8.3%), polypectomy and septal resection in 5 (20.8%) cases each, submucosal fibroid resection in 1 (4.2%) cases, tubal block released in 2 (8.3%).Conclusions: Hysteroscopy was found the best method in evaluation of intrauterine conditions for subfertility and also the type and location of uterine abnormalities can be precisely noted. The removal of those changes during operative hysteroscopy increases the fertility rate in women treated during this procedure.