- Visibility 105 Views
- Downloads 41 Downloads
- Permissions
- DOI 10.18231/j.sajhp.2024.004
-
CrossMark
Hysteroscopy as a comprehensive diagnostic and therapeutic tool in infertility management
- Author Details:
-
Anita Inani *
Anita Inani *
Introduction
Infertility is characterized as childlessness after 1year of unprotected intercourse. This is otherwise called sub ripeness. It influences 10-15% of couples in the regenerative age group.[1] Infertility addresses a day to day existence emergency to the couple encountering it. It might seriously influence the couple's mental concordance, sexual life and has numerous social ramifications. Consequently every gynecologist wonders whether or not to affirm barrenness until the individual in question has completely depleted all demonstrative and helpful modalities.
The consciousness of fruitlessness is expanded these days and multicentric way to deal with the treatment have been presented, yet the administration of barrenness is dependably challenging.[2]
Normal fertility depends on various male and female factors. Hysteroscopy is utilized for perception of Uterine cavity and cervical canal. Hysteroscopy can be consolidated in one meeting to allow a full study of the Uterine cavity and cervical canal and is valuable in distinguishing the reason for barrenness in female[3]
This likewise limits the emergency clinic stay of the barren individual for examinations.[4]
Materials and Methods
Study was conducted at Index Medical College Hospital and Research Centre in Dec 2013 to July 2015. All those patients who satisfied the inclusion criteria mentioned below were included in the study and those who had one or more criteria mentioned while exclusion criteria were deleted from the study. Thus 200 patients were selected for the study.The scheduled investigations were done to determine fitness for surgery. Patient was admitted one day prior to the procedure, and pre anaesthetic checkup was done. Hysteroscopy was scheduled in preovulatory period between day 5 and day 8 of cycle and done under general anesthesia.
Inclusion criteria
All the women aged between 20 to 40 years, attending outpatient with primary and secondary infertility.
To evaluate the cause in women with primary & secondary infertility with normal semen analysis of husband.
Exclusion criteria
Severe cardiac or respiratory disease
Generalised peritonitis
Diaphragmatic hernia
Umbilical hernia
Result
|
Duration of infertility in years |
Primary infertility |
Secondary infertility |
Total |
|||
|
|
No. |
% |
No. |
% |
No. |
% |
|
20-25 |
86 |
57.3 |
17 |
34 |
103 |
51.5 |
|
26-30 |
49 |
32.6 |
29 |
58 |
78 |
39 |
|
31-35 |
07 |
4.6 |
02 |
04 |
09 |
4.5 |
|
36-40 |
08 |
5.5 |
02 |
04 |
10 |
05 |
|
Total |
150 |
100 |
50 |
100 |
200 |
100 |
|
Duration of infertility in years |
Primary infertility |
Secondary infertility |
Total |
|||
|
|
No. |
% |
No. |
% |
No. |
% |
|
Normal |
19 |
12.6 |
07 |
14 |
26 |
13 |
|
Abnormal |
73 |
48.6 |
21 |
42 |
94 |
47 |
|
Hyperemia (congestion) |
18 |
12 |
05 |
10 |
23 |
11.5 |
|
Polyp |
13 |
8.6 |
03 |
06 |
16 |
08 |
|
Septum |
08 |
5.3 |
05 |
10 |
13 |
6.5 |
|
Atrophy/scarred |
07 |
4.6 |
04 |
08 |
11 |
5.5 |
|
Adhesions |
05 |
3.3 |
03 |
06 |
08 |
04 |
|
Fibroid |
07 |
4.6 |
02 |
04 |
09 |
4.5 |
|
Total |
150 |
100 |
50 |
100 |
200 |
100 |
|
Duration of infertility in years |
Primary infertility |
Secondary infertility |
Total |
|||
|
|
No. |
% |
No. |
% |
No. |
% |
|
Septal resection |
04 |
2.6 |
10 |
20 |
14 |
07 |
|
Polypectomy |
55 |
36.6 |
11 |
22 |
66 |
33 |
|
Adhesiolysis |
72 |
48 |
20 |
40 |
92 |
46 |
|
Myomectomy |
19 |
12.6 |
09 |
18 |
28 |
14 |
|
Total |
150 |
100 |
50 |
100 |
200 |
100 |
Discussion
Diagnostic hysteroscopy provides a reliable information in evaluation of uterine cavity and detection of intrauterine diseases.[5], [6], [7], [8] Mean prevalence of uterine malformation in general population is 4.3%, in infertility is 3.5% and in recurrent pregnancy loss 13%.
The incidence of uterine anomaly is 7.6%. Subseptate and septate uterus is the most common uterine malformation in our study, which is undiagnosed by prior USG.
Septate uterus is the most common uterine anomaly associated with increased reproductive failure rates.[9] The reproductive performance of uncorrected septum is poor like 80% pregnancyloss, 10%preterm delivery, 10% term delivery. Pregnancy outcome improved after surgical correction in to 80% term, 5% preterm delivery,15% pregnancy loss. Complication rate of diagnostic hysteroscopy is low as 0.012%. In view of low complication, less time consuming hysteroscopy could be done in all infertility patients undergoing diagnostic laparoscopy.[10], [11], [12]
Diagnostic and therapeutic hysteroscopy having low complications(0.012%) and is less time consuming.[13], [14][15][16]
Conclusion
Hysteroscopy may appear to be invasive, but is more beneficial, as diagnosis and therapeutic interventions can be done at the same sitting.
Source of Funding
None.
Conflict of Interest
None.
References
- Shokeir T, Shalan H, El-Shafei M. Significance of endometrial polyps detected hysteroscopically in eumenorrheic infertile women. J Obstet Gynaecol Res. 2004;30(2):84-93. [Google Scholar]
- Hucke J, Bruyne D, Balan F. Hysteroscopy in infertility - diagnosis and treatment including falloposcopy. Contri Gynecol Obstet. 2000;20:13-20. [Google Scholar]
- Baur R, Creling W, Dietrich K. Small diameter laparoscopy using a microlaparoscope. Hum Reprod. 1996;13(4):298-305. [Google Scholar]
- Kaminski P, Gajewska M, Wielgos M, Szymusik I, Ziolkowska K, Bartkowiak R. The usefulness of laparoscopy and hysteroscopy in the diagnosis and treatment of infertility. Neuro Endocrinol Lett. 2006;27(6):813-20. [Google Scholar]
- Jayakrishnan K, Aby K, Koshy R. Role of laparohysteroscopy in women with normal pelvic imaging and failed ovulation stimulation with intrauterine insemination. J Hum Reprod Sci. 2010;3(1):20-4. [Google Scholar]
- Lall GS, Debdatta S, Suhash M, Ranjan GA. Comparative evaluation of sonosalpingography hysterosalpingography, and laparoscopy for determination of tubal patency. Obstet Gynecol India. 2007;57(2):158-61. [Google Scholar]
- Naz T, Hassan L, Sultan S, Nighat F. Laparoscopic evaluation in infertility. J Coll Physician Surg Pak. 2009;19(11):704-11. [Google Scholar]
- Woolcott R, Petchpud A. Wool cott et al the efficacy of hysteroscopy comparison of woman presenting with infertility vs other gynecological symptoms Aust Nj. Aust N Z J Obstet Gynaecol. 1995;35(3):310-3. [Google Scholar]
- Chanu S, Pal G, Panda S, Singh A. Diagnostic hysterolaparoscopy for evaluation of infertility: Our experience in a tertiary care hospital. J Hum Reprod Sci. 2018;11(1):19-23. [Google Scholar]
- Zhang E, Zhang Y, Fang L, Li Q, Gu J. Combined Hysterolaparoscopy for the Diagnosis of Female Infertility: a Retrospective Study of 132 Patients in China. Mater Sociomed. 2014;26(3):156-63. [Google Scholar]
- Mehta A, Modi A, Raval B, Munshi S, Patel S, Dedharotiya S. Role of diagnostic hysterolaparoscopy in the evaluation of infertility. Int J Reprod Contracept Obstet Gynecol. 2016;5:437-77. [Google Scholar]
- Selim R, Gergawy A, Shaheen K, Balaha M. The role of combined diagnostic hysterolaparoscopy in unexplained infertility. Int Surg J. 2022;9:1395-405. [Google Scholar]
- Miller J, Weinberg R, Canino N, Klein N, Soules M. The pattern of infertility diagnoses in women of advanced reproductive age. Am J Obstet Gynecol. 1999;181(4):952-9. [Google Scholar]
- Mol B, Collins J, Burrows E, Veen FD, Bossuyt P. Comparison of hysterosalpingography and laparoscopy in predicting fertility outcome. Hum Reprod. 1999;14(5):1237-79. [Google Scholar]
- Parveen M. Role of combined diagnostic laparoscopy and simultaneous diagnostic hysteroscopy for evaluation of female subfertility actors. J Surg Pak. 2010;15(1):44-7. [Google Scholar]
- Godinjak Z, Idrizbegovic E. Should diagnostic hysteroscopy be a routine procedure during diagnostic laparoscopy in infertile women?. Reprod Biomed Online. 2008;8:44-7. [Google Scholar]