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

Öz

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

Abstract

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

Kaynakça

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