[Which is the method of choice for evaluating uterine cavity in infertility workup?]

Diagnostic Value of Ultrasonography Combined with Hysteroscopy in Intrauterine Space-Occupying Abnormalities

The aim of this study was to analyze the diagnostic significance of ultrasonography combined with hysteroscopy for intrauterine space-occupying abnormalities. A total of 99 patients with uterine space-occupying abnormalities treated in hospitals were enrolled. The patients were divided into three groups according to different disease types: the submucosal myoma group, endometrial polyp group, and placenta residue group, with 33 patients in each group. The differences and diagnostic effects in intrauterine ultrasound, hysteroscopic findings, and surgical histopathology were observed in each group. Outcome measures: it was to compare the sensitivity, specificity, and accuracy of intrauterine ultrasound and angiography for intrauterine space-occupying lesions using surgical and pathological examination methods as the gold standard; the relationship between the location, number, size, appearance, and serosal layer of intrauterine lesions was clearly shown; the location, number, appearance, and echogenicity of space-occupying abnormalities under hysteroscopy were observed. The results showed that the diagnostic rates of endometrial polyps, submucous myoma, and residual placenta were 90.9%, 80.8%, and 72.7%, respectively. However, the sensitivity, specificity, and accuracy of ultrasonography in the diagnosis of endometrial polyps were 90.0%, 66.7%, and 87.9%, respectively; those of hysteroscopy in the diagnosis of endometrial polyps were 96.7%, 66.7%, and 93.9%, respectively; and combined diagnosis was 96.7%, 100.0%, 97.0%, 100.0%, and 75.0%. The sensitivity, specificity, and accuracy of ultrasonography in the diagnosis of submucous myoma of the uterus were 88.9%, 50.0%, and 81.8%, respectively; those of hysteroscopy in the diagnosis of submucous myoma of the uterus were 96.3%, 83.3%, and 93.9%, respectively; and combined diagnosis was 100.0%, 83.3%, 97.0%, 96.4%, and 100.0%. The sensitivity, specificity, and accuracy of ultrasonography in the diagnosis of uteroplacental remnants were 87.5%, 66.7%, and 81.8%, respectively; those of hysteroscopy in the diagnosis of uteroplacental remnants were 91.7%, 77.8%, and 87.9%, respectively; and combined diagnosis was 95.8%, 88.9%, 93.9%, 95.8%, and 88.9%. In summary, ultrasonography combined with hysteroscopy can improve the diagnostic sensitivity and accuracy for intrauterine space-occupying abnormalities.

Hysteroscopy as a Primary Tool in Exploration and Treatment of Infertility: Single Center Experience in Western Romania

(1) Background: Infertility is a disease that affects millions of individuals worldwide. Intrauterine lesions are common in infertile women, hysteroscopy being considered the gold standard for assessing them, even if in routine clinical practice indirect imaging techniques are the first-line investigative tools. The aim of the study was to evaluate hysteroscopic findings among women with unexplained infertility and to analyze fertility outcomes after operative hysteroscopy; (2) Methods: a retrospective cohort study was conducted among 198 women with infertility that had undergone hysteroscopy as the first step of their infertility workup. (3) Results: The median age of the participants was 34 years, 67.7% of them being diagnosed with primary infertility. The most common abnormalities were endometrial polyps, uterine synechiae and uterine fibroids. In addition, pregnancy rates were 23.1% after hysteroscopic polypectomy, 11.1% after hysteroscopic myomectomy and 23.8% after uterine synechiae resection; (4) Conclusions: Endometrial polyps were the most common uterine abnormality found in women with infertility. Hysteroscopic interventions appeared to increase pregnancy rates and outcomes among these women.

Three-dimensional 3D ultrasound combined with power Doppler for the differential diagnosis of endometrial lesions among infertile women

OBJECTIVE

To assess three-dimensional (3D) ultrasound combined with power Doppler (PD) for the differential diagnosis of endometrial lesions among infertile women.

METHODS

A prospective study carried out at a reproductive medicine center in Luoyang, China, between January and December 2015. The inclusion criteria were asymptomatic infertility with normal endometrium or specific endometrial lesions. Participants were subdivided by whether they had normal endometrium (group 1, n=357), or endometrial lesions including polyps, hyperplasia, intrauterine adhesions, or endometritis (group 2, n=99). 3D PD and hysteroscopy were performed in the follicular phase. Endometrial thickness, volume, vascularization index (VI), flow index (FI), and vascularization flow index (VFI), and subendometrial VI, FI, and VFI were calculated. Endometrial lesions were confirmed by pathologic analysis.

RESULTS

The overall prevalence of endometrial lesions was 99/456 (21.3%). Endometrial thickness and volume were significantly larger in group 2 than in group 1 (9.96 ± 3.24 vs 8.15 ± 2.50 mm and 3.70 ± 2.54 vs 2.42 ± 1.64 cm³ , respectively; both P<0.001). Endometrial thickness and volume were larger among women with endometrial polyps and hyperplasia; endometrial VI, FI, and VFI were lower among women with intrauterine adhesions.

CONCLUSION

Three-dimensional PD has value for the differential diagnosis of endometrial lesions among infertile women.

CLINICAL TRIAL REGISTRATION

The trial is registered in the Chinese Clinical Trial Registry as ChiCTR1800015799.

What is the role of hysteroscopic surgery in the management of female infertility? A review of the literature

The position of hysteroscopy in current fertility practice is under debate. There are many randomized controlled trials on technical feasibility and patient compliance demonstrating that the procedure is well tolerated and effective in the treatment of intrauterine pathologies. However, no consensus on the effectiveness of hysteroscopic surgery in improving the prognosis of subfertile women is available. A literature review was performed to explore the available information regarding the role of hysteroscopy in the evaluation and management of female infertility as well as to ascertain evidence that treatment of these uterine abnormalities improves fertility. The debate regarding the role of hysteroscopic surgery in the management of female infertility remains as the published studies did not reach a consensus on the benefit of such an intervention in this setting. The randomized trials do not clearly demonstrate that surgical correction of all intrauterine abnormalities improves IVF outcome. However, published observational studies suggest a benefit for resection of submucosal leiomyomas, adhesions, and endometrial polyps in increasing pregnancy rates. More randomised controlled studies are needed to substantiate the effectiveness of the hysteroscopic removal of suspected intrauterine pathology in women with unexplained subfertility or prior to assisted reproductive technology.

Diagnostic accuracy of transvaginal sonography in the detection of uterine abnormalities in infertile women

BACKGROUND

Accurate diagnosis of uterine abnormalities has become a core part of the fertility work-up. A variety of modalities can be used for the diagnosis of uterine abnormalities.

OBJECTIVES

This study was designed to assess the diagnostic accuracy of transvaginal ultrasonography (TVS) in uterine pathologies of infertile patients using hysteroscopy as the gold standard.

PATIENTS AND METHODS

This was a cross-sectional study carried out in the Department of Reproductive Imaging at Royan Institute from October 2007 to October 2008. In this study, the medical documents of 719 infertile women who were investigated with transvaginal ultrasound (TVS) and then hysteroscopy were reviewed. All women underwent hysteroscopy in the same cycle time after TVS. Seventy-six out of 719 patients were excluded from the study and 643 patients were studied. TVS was performed in the follicular phase after cessation of bleeding. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for TVS. Hysteroscopy served as the gold standard.

RESULTS

The overall sensitivity, specificity, positive and negative predictive values for TVS in the diagnosis of uterine abnormality was 79%, 82%, 84% and 71%, respectively. The sensitivity and PPV of TVS in detection of polyp were 88.3% and 81.6%, respectively. These indices were 89.2% and 92.5%, respectively for fibroma, 67% and 98.3%, respectively for subseptated uterus and 90.9% and 100%, respectively for septated uterus. Adhesion and unicornuated uterus have the lowest sensitivity with a sensitivity of 35% and PPV of 57.1%.

CONCLUSION

TVS is a cost-effective and non-invasive method for diagnosis of intrauterine lesions such as polyps, submucosal fibroids and septum. It is a valuable adjunctive to hysteroscopy with high accuracy for identification and characterization of intrauterine abnormalities. This may lead to a more precise surgery plan and performance.