Intrauterine cavity assesment prior an infertility treatment; the comparison of transvaginal sonography and office hysteroscopy

Yıl 2009, Cilt: 40 Sayı: 4, 167 - 171, 01.05.2009

Gazi Yıldırım Cem Fıçıcıoğlu Rukset Attar Ateş Karateke Narter Yeşildağlar

Öz

: Hysteroscopy is a gold standart to detect the intrauterine pathologies. Thus, it has been argued to be a part of a routine infertility testing. We designed this study to demonstrate the importance of routine ofice hysteroscopic examination and the comparision of transvaginal ultrasonography with hysteroscopic findings. Materials and Methods: Routine transvaginal ultras onograpic examination was performed all patients younger than 38 years old who want to conceive. Only 136 of204 patients who has been suspected an intrauterine abnormality in the transvaginal ultrasonography were accepted to be applied diagnostic hysteroscopy. One hundred and eight patients who has been diagnosed normal with ultrasonography were accepted to applied the hysteroscopic examination with informed consent. One hundred and twelve of these 244 patients were required intravenous sedation, and 90 of244 needed cervical dilatation. Endol supp 100 mg was performed to the all patients just 20 minutes before procedure and none of them developed a complication. Wolf 5 mm working channel hysteroscop was applied during the procedure. Results: The detection rates of intrauterine pathologies with transvaginal ultrasonography were comparable with literature (Sensitivity: 82.8%, Spesifisity: 80.8%, False pozitive: 14.7%, False negative: 22.2%, Pozitive predictive value: 85.3%, Negative predictive value: 77.8%). Twenty patients of 136 who had a intrauterine pathologic findings with ultrasonography were revealed as a normal with hysteroscopy. But 24 patients 108 (22.2Vo) showed a intrauterine pathology with hysteroscopy beside their ultrasonograhy were assessed normal (12 polyp, 3 hyperplastic endometrium, 5 adhesion, 4 a uterine anomaly like arcuat, subseptus and septus). Discussion: Currently hysteroscopy can be applied as an office procedure without anesthesia in paralel to the development of optical technology and the small size of telescopic instruments. So it can be use as an routine infertility screening tool even in asymptomatic patients.

Anahtar Kelimeler

Infertility, Ultrasonography, Hysteroscopy, Sensitivity and Specificity

İnfertilite tedavileri öncesi uterin kavite değerlendirilmesinde transvajinal ultrasonografi ve ofis histeroskopinin karşılaştırılması

Öz

Giriş: Histeroskopi uterin kavite patolojilerini saptamada altın standart bir yöntemdir. Bu nedenle temel infertilite araştırmalarının bir parçası olması gerektiği tartışılagelmiştir. Biz bu çalışmamızda ofis histeroskopinin temel infertilite araştırması içinde yer almasını vurgulamak için planladık. Gereç ve Yöntem: Merkezimize iki yıl içersinde başvuran 38 yaşından küçük, ilk tedavisini olacak hastalara rutin transvajinal ultrasonografi uygulandı. Ultrasonografide patolojik bir bulgu saptanan hastalardan 204 tanesine ofis histeroskopi önerildi ancak 136 vaka işleme onam verdiği için müdahaleye alındı. Ultrasonografide hiçbir patolojisi olmayan hastalarımıza da bu projeden bahsedildi ve onam verenlerin 108 tanesine ofis prosedürü olarak histeroskopi uygulandı. 244 hastadan sadece 112 tanesine sedasyon ve 90 tanesinde de servikal dilatasyon gerekti. Hastalara işlemden 20 dk öncesi Endol supp 100 mg pr uygulandı. Uygulama Wolf 5 mm Working Channel histeroskopi sitemi ile yapıldı. Herhangi bir komplikasy on ile karşılaşılmadı. Bulgular: Transvajinal ultrasonografinin uterin kavite patolojilerini belirlemedeki parametreleri literatür ile karşılaştırılabilir oranlarda idi (Sensitivite: %82.8, Spesifîsite: %80.8, Yalancı Pozitiflik: %14.7, Yalancı Negatiftik: %22.2, PPV: %85.3, NPV: %77,8). Uterin kavitede patolojiden şüphelenilen 136 vakanın 20 tanesinde histeroskopide herhangi bir problem izlenmedi. Fakat ultrasonografide normal denilen 108 vakanın 24 tanesinde (%22) sinde histeroskopide bir patoloji izlenmekte idi (12 tanesinde polip, 3 tanesinde hiperplastik endometriyum, 5 tanesinde adezyon, 4 tanesinde de arcuat, subseptus veya septum uteri gibi bir uterin anomali). Sonuç: Invazif bir yöntem olmasına karşın günümüzde optik teknolojideki gelişmelere paralel olarak teleskop çaplarının küçülmesi ve hekimlerin tecrübelerinin artması histeroskopi uygulamalarını anestezi vermeden analjezi uygulayarak ofis şartlarında yapılabilir hale getirmiştir.

Anahtar Kelimeler

Kısırlık, Ultrasonografi, Histeroskopi, Duyarlılık ve özgüllük

Kaynakça

• 1. Hassa H, Tekin B, Tanır HM, Çakmak B. Ofis Histeroskopi. TJOD Dergisi 2007;4(2):127-133
• 2. Brown SE, Coddington CC, Schnorr J, Toner JP, Gibbons W, Oehninger S. Evaluation of outpatient hysteroscopy, saline infusion hysterosonography, and hysterosalpingography in infertile women: a prospective, randomized study. Fertil Steril 2000; 74:1029-1034
• 3. Romano F, Cicinelli E, Anastasio PS, Epifani S, Fanelli F, Galantino P. Sonohysterography versus hysteroscopy for diagnosing endouterine abnormalities in fertile women. Int J Gynaecol Obstet 1994;45:253-260
• 4. Mooney SB, Milki AA. Effect of hysteroscopy performed in the cycle preceding controlled ovarian hyperstimulation on the outcome of in vitro fertilization. Fertil Steril. 2003;79:637-638
• 5. Should hysteroscopy be a part of the basic infertility workup? Hum Reprod. 1999 A ug;14(8):1923-4
• 6. Minihysteroscopy as routine diagnostic procedure in women with primary infertility. J Am Assoc Gynecol Laparosc. 2003 Aug; 10(3): 396-8
• 7. Mittal K, Schwartz L, Goswami S, Demopoulos R. Estrogen and progesterone receptor expression on endometrial polyp. Int J Gynecol Obstet Invest 1994;38:217-219
• 8. Tahir MM, Bigrigg MA, Browning JJ. A Randomised controlled trial comparing transvaginal ultrasound, outpatient hysteroscopy and endometrial biopsy with inpatient hysteroscopy and curettage. BJOG 1999;106:1259-64
• 9. Goldenberg M, Bider D, Ben-Rafael Z, Dor J, Levrarı D, Oelsner G, Mashiach S. Hysteroscopy in a program of in vitro fertilization. Jin Vitro Fert Embryo Transf 1991;8:336-8
• 10. Dicker D, Goldman J A, 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. J In Vitro Fert Embryo Transf 1990;7:267-70
• 11. Golan A, Ron-El R, Herman A, Soffer Y, Bukovsky I, Gaspi E. Diagnostic hysteroscopy: its value in an in-vitro fertilization/embryo transfer unit. Hum Reprod 1992;7:1433-4
• 12. Shamma FN, Lee G, Gutmann JN, Lavy G. The role of office hysteroscopy in in vitro fertilization. Fertil Steril 1992;58:1237-9
• 13. Tavmergen E, Adakan F, Göker ENT. İnnfertil kadınlarda histerosalpingografi (HSG) ile histeroskopinin karşılaştırılması. Türk Fertilite Dergisi 1999;7:151-4
• 14. Golan A, EilatE, Ron-El R, Herman A, Soffer Y, Bukovsky I. Hysteroscopy is superior to hysterosalpingography in infertility investigation. Acta Obstet Gynecol Scand 1996;75:654-6
• 15. Kökden A, liter E, Karalök H, Tüfekçi EC, Temelli F. Anormal uterin kanamalı kadınların değerlendirilmesinde, Transvajinal ultrason, sonohisterografi ve endometrial biopsinin karşılaştırılması. TJOD Dergisi 2005; 2 (4):327- 331
• 16. Williams DC, Paul BM, Cvharlotte NC. A prospective study of transvaginal hydrosonography in the evaluation of abnormal uterine bleeding. Am J. Obstet. Gynecol 1998;179:292-298
• 17. Vries LD, Dijkhuizen FP, Fol BW, Brolmann HA, Moret E. Heintz A.P. Comparison of transvaginal ultrasonography, saline infusion sonography and hysteroscopy in premenopausal women with abnormal uterine bleeding. J. Clin. Ultrasound 2000;28:217-227
• 18. Kıran H, Kaplanoğlu M,. Çetin MT. Sonohysterography of the Uterine Cavity with Hysteroscopic Correlation in the Investigation of Infertility. J Turkish-German Gynecol Assoc 2008; 9(2); 94-96 19. Yucebilgin MS, Aktan E, Bozkurt K et al. Comparison of hydrosonography and diagnostic hysteroscopy in the evaluation of infertile patients. Clin Exp Obstet Gynecol 2004;31(l):56-8
• 20. de Kroon CD, de Bock GH, Dieben SW, Jansen FW. Saline contrast hysterosonography in abnormal uterine bleeding: a systematic review and metaanalysis. BJOG 2003 Oct; 110(10):938-47
• 21. Ragni G, Diaferia D, Vegetti W et al. Effectiveness of sonohysterography in infertile patient work-up: a comparison with transvaginal ultrasonography and hysteroscopy. Gynecol Obstet Invest 2005;59(4):184-8
• 22. De Sutter P. Rational diagnosis and treatment in infertility. Best Pract Res Clin Obstet Gynaecol. 2006 Oct;20(5):647-64.