Objective. To study incidence of abnormal hysteroscopic findings according to age. Methods. We retrospectively studied 557 consecutive office hysteroscopies in patients referred for incapacity to conceive lasting at least 1 year or prior to in vitro fertilization. Rates of abnormal findings were reviewed according to age. Results. In 219 cases, hysteroscopy showed an abnormality and more than a third of our population had abnormal findings that could be related to infertility. Rates of abnormal findings ranged from 30% at 30 years to more than 60% after 42 years. Risk of abnormal finding was multiplied by a factor of 1.5 every 5 years. Conclusion. Our data are an additional argument to propose office hysteroscopy as part of first-line exams in infertile woman, regardless of age. 1. Introduction Hysteroscopy is the gold standard procedure for uterine cavity exploration [1]. However, the World Health Organization (WHO) recommends hysterosalpingography (HSG) alone for management of infertile women [2]. The explanation for this discrepancy is that HSG provides information on tubal patency or blockage. Office hysteroscopy is only recommended by the WHO when clinical or complementary exams (ultrasound, HSG) suggest intrauterine abnormality [3] or after in vitro fertilization (IVF) failure [4]. Nevertheless, many specialists feel that hysteroscopy is a more accurate tool because of the high false-positive and falsenegative rates of intra uterine abnormality with HSG [1, 5, 6]. This explains why many specialists use hysteroscopy as a first-line routine exam for infertility patients regardless of guidelines. The aim of this retrospective study is to describe hysteroscopy findings in a population of 557 infertile patients. 2. Materials and Methods We analyzed retrospectively 557 patients referred for hysteroscopy for incapacity to conceive lasting at least 1 year or prior to IVF, from November 2002 to July 2006. This population represents one third of hysteroscopies on that period. All hysteroscopies were performed by the same operator (JLM). Procedures lasted approximately two minutes without anesthesia or cervical preparation in an office gynecology setting. Diagnostic video-assisted hysteroscopy was performed using a flexible hysteroscope (flexible hysteroscope, Olympus HYF-P, Paris, France) with an outer diameter of 3.1？mm. Procedures were not video recorded. The uterine cavity was expanded under manual hydrostatic pressure (saline solution). Hysteroscopy was performed with a standard sequence, inspecting the endocervical canal, uterine cavity, endometrium,
References
[1]
A. Golan, E. Eilat, R. Ron-El, A. Herman, Y. Soffer, and I. Bukovsky, “Hysteroscopy is superior to hysterosalpingography in infertility investigation,” Acta Obstetricia et Gynecologica Scandinavica, vol. 75, no. 7, pp. 654–656, 1996.
[2]
P. C. Rowe, T. Hargreave, and H. Mellows, WHO Manual for the Standardized Investigation and Diagnosis of the Infertile Couple, The Press Syndicate of the University of Cambridge, Cambridge, UK, 1993.
[3]
A. C. de Sa Rosa e de Silva, J. C. Rosa e Silva, F. J. Candido dos Reis, A. A. Nogueira, and R. A. Ferriani, “Routine office hysteroscopy in the investigation of infertile couples before assisted reproduction,” Journal of Reproductive Medicine for the Obstetrician and Gynecologist, vol. 50, no. 7, pp. 501–506, 2005.
[4]
J. P. Balmaceda and I. Ciuffardi, “Hysteroscopy and assisted reproductive technology,” Obstetrics and Gynecology Clinics of North America, vol. 22, no. 3, pp. 507–518, 1995.
[5]
R. F. Valle, “Hysteroscopy in the evaluation of female infertility,” American Journal of Obstetrics and Gynecology, vol. 137, no. 4, pp. 425–431, 1980.
[6]
C. Prevedourakis, D. Loutradis, C. Kalianidis, N. Makris, and D. Aravantinos, “Hysterosalpingography and hysteroscopy in female infertility,” Human Reproduction, vol. 9, no. 12, pp. 2353–2355, 1994.
[7]
D. Dicker, J. A. Goldman, J. Ashkenazi, D. Feldberg, and A. Dekel, “The value of hysteroscopy in elderly women prior to in vitro fertilization-embryo transfer (IVF-ET): a comparative study,” Journal of In Vitro Fertilization and Embryo Transfer, vol. 7, no. 5, pp. 267–270, 1990.
[8]
G. F. Brusco, S. Arena, and A. Angelini, “The role of diagnostic hysteroscopy in infertile women,” Minerva Ginecologica, vol. 53, no. 5, pp. 313–316, 2001.
[9]
S. Preutthipan and V. Linasmita, “A prospective comparative study between hysterosalpingography and hysteroscopy in the detection of intrauterine pathology in patients with infertility,” Journal of Obstetrics and Gynaecology Research, vol. 29, no. 1, pp. 33–37, 2003.
[10]
M. Pansky, M. Feingold, R. Sagi, A. Herman, D. Schneider, and R. Halperin, “Diagnostic hysteroscopy as a primary tool in a basic infertility workup,” Journal of the Society of Laparoendoscopic Surgeons, vol. 10, no. 2, pp. 231–235, 2006.
[11]
P. J. Taylor, D. Lewinthal, A. Leader, and H. A. Pattinson, “A comparison of Dextran 70 with carbon dioxide as the distention medium for hysteroscopy in patients with infertility or requesting reversal of a prior tubal sterilization,” Fertility and Sterility, vol. 47, no. 5, pp. 861–863, 1987.
[12]
S. E. Brown, C. C. Coddington, J. Schnorr, J. P. Toner, W. Gibbons, and S. Oehninger, “Evaluation of outpatient hysteroscopy, saline infusion hysterosonography, and hysterosalpingography in infertile women: a prospective, randomized study,” Fertility and Sterility, vol. 74, no. 5, pp. 1029–1034, 2000.
[13]
A. Magos, A. Al-Khouri, P. Scott, et al., “One stop fertility clinic,” Journal of Obstetrics and Gynaecology, vol. 25, no. 2, pp. 153–159, 2005.
[14]
G. B. La Sala, R. Montanari, L. Dessanti, C. Cigarini, and F. Sartori, “The role of diagnostic hysteroscopy and endometrial biopsy in assisted reproductive technologies,” Fertility and Sterility, vol. 70, no. 2, pp. 378–380, 1998.
[15]
T. A. Shokeir, H. M. Shalan, and M. M. El-Shafei, “Combined diagnostic approach of laparoscopy and hysteroscopy in the evaluation of female infertility: results of 612 patients,” Journal of Obstetrics and Gynaecology Research, vol. 30, no. 1, pp. 9–14, 2004.
[16]
R. Campo, Y. Van Belle, L. Rombauts, I. Brosens, and S. Gordts, “Office mini-hysteroscopy,” Human Reproduction Update, vol. 5, no. 1, pp. 73–81, 1999.
[17]
T. Silberstein, O. Saphier, B. J. van Voorhis, and S. M. Plosker, “Endometrial polyps in reproductive-age fertile and infertile women,” Israel Medical Association Journal, vol. 8, no. 3, pp. 192–195, 2006.
[18]
B. Sanders, “Uterine factors and infertility,” The Journal of Reproductive Medicine, vol. 51, no. 3, pp. 169–176, 2006.
[19]
R. Frydman and J. C. Belaisch-Allart, “Results of in vitro fertilization for endometriosis,” Contributions to Gynecology and Obstetrics, vol. 16, pp. 328–331, 1987.
[20]
E. Cicinelli, L. Resta, R. Nicoletti, V. Zappimbulso, M. Tartagni, and N. Saliani, “Endometrial micropolyps at fluid hysteroscopy suggest the existence of chronic endometritis,” Human Reproduction, vol. 20, no. 5, pp. 1386–1389, 2005.
