Our Office-Based Diagnostic Hysteroscopy Results of Pre-IVF Patients

Öz

Objective: To evaluate the intrauterine pathologies using office-based hysteroscopy (OH) in patients scheduled for assisted reproductive technologies (ART). Materials and Methods: This study was conducted at the In Vitro Fertilization (IVF) Unit of Firat University Hospital, between March 2010- January 2012. The 219 patients with no OH within the previous 6 months were enrolled the study with rigid hysteroscope (continous flow; 30-degree forward-oblique view) assembled in a 4-mm diameter diagnostic sheath with an atraumatic tip. After OH investigation, endometrial sampling was performed with biopsy catheter. The patients in whom the findings were normal proceeded to an IVF cycle within 1 month. Results: The procedure was succesful in 219 patients, with mean (±SD) age of 31.9 (±5.2) years, duration of infertility of 6.2 (±4.5) years and number of previous ART trials 1.6 (±1.1). The type of infertility were as follows: 150 primary (68.5%) and 69 secondary infertility (31.5%). Endometrial polyp and uterine subseptum were the major intracavitary abnormalities. Chronic endometritis and endometrial polyp were the major histopathologic abnormalities. Chronic endometritis, uterine subseptum and endometrial hyperplasia were higher in patients ≥35 years (p

Anahtar Kelimeler

• Office hysteroscopy, IVF failure, endometrial pathology

IVF Ön Hazırlığı Yapılan Hastalardaki Diagnostik Histeroskopi Sonuçlarımız

Öz

Amaç: Çalışmamızda invitro fertilizasyon (IVF) tedavisi programına alınmış hastalarda ofis histeroskopi (OH) ile saptanacak intrauterin patolojileri ortaya çıkarmayı amaçladık. Gereç ve Yöntem: Bu retrospektif çalışmaya Fırat Üniversitesi Hastanesi IVF Ünitesi'nde Mart 2010- Ocak 2012 tarihleri arasında tüp bebek programına alınan ve OH yapılan 219 hasta dahil edildi. Rijid, 30 derece ileri oblik görüşlü-sürekli akımlı, 4mm çaplı, diagnostik histeroskop son 6 ayda ve daha önce OH yapılmamış hastalara uygulandı. OH takiben biyopsi kateteri ile endometrial örnekleme yapıldı. Bulguları normal olan hastalar takip eden 1 ay içinde IVF siklusuna alındı. Bulgular: Hastaların ortalama yaşı 31.9 (±5.2) yıl, infertilite süresi 6.2 (±4.5) yıl ve daha önceki IVF deneme sayısı 1.6 (±1.1) adet idi. Hastaların %68.5'i primer infertil, %31.5'i sekonder infertil idi. İntrakaviter major anomaliler uterin subseptum ve endometrial polip idi. Histopatolojik major bulgular kronik endometrit ve endometrial hiperplazi idi. Kronik endometrit, uterin subseptum ve endometrial hiperplazi patolojileri 35 yaş üstü hastalarda daha fazla idi (p

Anahtar Kelimeler

• Ofis histeroskopi, IVF başarısızlığı, Endometrial patoloji

Kaynakça

1. Grİnlund L, Hertz J, Helm P, Colov NP. Transvaginal sonohysterography and hysteroscopy in the evaluation of female infertility, habitual abortion or metrorrhagia. A comparative study. Acta Obstet Gynecol Scand 1999; 78: 415-8.
2. Granberg S, Wikland M, Karlsson B, Norstrom A, Friberg LG. Endometrial thickness as measured by endovaginal ultrasonography for identifying endometrial abnormalities. Am J Obstet Gynecol 1991; 164: 47–52. 10
3. Guven MA, Bese T, Demirkiran F, Idil M, Mgoyi L. Hydrosonography in screening for intracavitary pathology in infertile women. Int J Gynaecol Obstet 2004; 86: 377-83.
4. Kim MR, Kim YA, Jo MY, Hwang KJ, Ryu HS. High frequency of endometrial polyps in endometriosis. J Am Assoc Gynecol Laparosc 2003; 10: 46-8.
5. Acien P. Incidence of Mullerian defects in fertile and infertile women. Hum Reprod 1997; 12: 1372–6.
6. Raga F, Bauset C, Remohi J, Bonilla-Musoles F, Simon C, Pellicer A. Reproductive impact of congenital Mullerian anomalies. Hum Reprod 1997; 12: 2277–81.
7. Daly DC, Maier D, Soto-Albors C. Hysteroscopic metroplasty: six years’ experience. Obstet Gynecol 1989; 73: 201–5.
8. Goldenberg M, Sivan E, Sharabi Z, Mashiach S, Lipitz S, Seidman DS. Reproductive outcome following hysteroscopic management of intrauterine septum and adhesions. Hum Reprod 1995; 10: 2663–5.

9. Grimbizis G, Camus M, Clasen K, Tournaye H, De Munck L, Devroey P. Hysteroscopic septum resection in patients with recurrent abortions or infertility. Hum Reprod 1998; 13: 1188– 9
10. Hamilton JA, Larson AJ, Lower AM, Hasnain S, Grudzinskas JG. Routine use of saline hysterosonography in 500 consecutive, unselected, infertile women. Hum Reprod 1998; 13: 24637
11. Barash A, Dekel N, Fieldust S, Segal I, Schechtman E, Granot I. Local injury to the endometrium doubles the incidence of successful pregnancies in patients undergoing in vitro fertilization. Fertil Steril 2003; 79: 1317-22.
12. Zhou L, Li R, Wang R, Huang HX, Zhong K. Local injury to the endometrium in controlled ovarian hyperstimulation cycles improves implantation rates. Fertil Steril 2008; 89: 1166-76.
13. Karimzadeh MA, Ayazi Rozbahani M, Tabibnejad N. Endometrial local injury improves the pregnancy rate among recurrent implantation failure patients undergoing in vitro fertilisation/intra cytoplasmic sperm injection: a randomised clinical trial. Aust N Z J Obstet Gynaecol 2009; 49: 677-80.
14. Gnainsky Y, Granot I, Aldo PB et al. Local injury of the endometrium induces an inflammatory response that promotes successful implantation. Fertil Steril 2010; 94: 2030-6.
15. Almog B, Shalom-Paz E, Dufort D, Tulandi T. Promoting implantation by local injury to the endometrium. Fertil Steril 2010; 94: 2026-9.
16. Romano S, Shimoni Y, Muralee D. Retrograde seeding of endometrial carcinoma during hysteroscopy. Gynecol Oncol 1992; 44: 116-8. Gönderilme Tarihi: 25.07.2012