Hysteroscopic evaluation in infertile patients: a prospective study

Background: Hysteroscopy is the gold standard procedure for uterine cavity exploration. However, hysteroscopy is only recommended by the WHO when clinical or complementary exams (ultrasound, HSG) suggest intrauterine abnormality or after in vitro fertilization failure. Nevertheless, many specialists feel that hysteroscopy is a more accurate tool. The aim of this prospective study is to assess the value of diagnostic hysteroscopy in a primary workup of infertility by describing hysteroscopy findings in a population of 324 infertile patients during 18 months (December 2010 - May 2012). Methods: We analysed prospectively 324 infertile patients in gynaecology OT setting. Diagnostic video-assisted hysteroscopy was performed using a flexible hysteroscope. Hysteroscopy was performed with a standard sequence, inspecting the endocervical canal, uterine cavity, endometrium, and tubal ostia and findings recorded. Results: Hysteroscopy was normal in 65.12% of patients. Cervico-isthmic abnormalities were present in 6.48% of patients with cervical stenosis being the major abnormality. Uterine cavity was normal in 86% of patients. Observed abnormalities were septate uterus in 10 cases, intrauterine synechiae in 16 cases, sub mucus myoma in 2 cases, deformed cavity in 10 cases and endometrial polyp in 2 cases. Ostial fibrosis was observed in 29 patients. Endometrial abnormalities (fibrosis, inflammation) were observed in 30 patients. Seven patients turned out to be of genital tuberculosis with endometrial biopsy. No significance was found regarding the total number of intrauterine pathologies when comparing the groups of primary versus secondary infertility. Conclusions: Rates of abnormal findings in infertile patient who underwent diagnostic hysteroscopy was 34.88% in our study. Our data are an additional argument to suggest hysteroscopy as part of investigation in infertile woman. Routine diagnostic hysteroscopy should be part of an infertility workup in primary and secondary infertility. [Int J Reprod Contracept Obstet Gynecol 2012; 1(1.000): 37-41]