Role of Hysteroscopy in Diagnosis and Treatment of Infertility Factors M.E.Parsanezhad M.D Professor...

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Role of Hysteroscopy inDiagnosis and Treatment of Infertility Factors

M.E.Parsanezhad M.DProfessor and chairDepartment of Gynecology & Obstetrics

Head: Reproductive Medicine & Infertility Division

E.Mail: parsame@rogers.com

Shiraz University of Medical Sciences

Tehran UMS, Congress 2014. Tehran IRAN

OBJECTIVETo determine whether routine hysteroscopy as a part of infertility evaluation…., and before ART, even in women without pathologic TVS or HSG findings, should be recommended.

INTRODUCTIION

Uterine factors represent only 2% to 3% of causes of infertility; however, abnormal intrauterine findings are present in approximately 25% of infertile women.

Hysteroscopy & Infertility

Uterine factors that benefit most from hysteroscopic evaluation are structural abnormalities that distort uterine cavity symmetry or obstruct the tubal passages:

submucous leiomyomas, intrauterine adhesions, uterine anomalies, and tubal cornual occlusions.

The mentioned lesions can interfere with spontaneous fertility and can compromise pregnancy rates in ART cycles.

Hysteroscpy Before ART?

More than 2/3 of infertile couples undergoing ART failed to conceive. Factors leading to failure of conception ..1-Suboptimal ovarian stimulation2- Poor embryo quality, 3-Impaired uterine receptivity.

The incidence of uterine abnormalities including endometritis , submucosal myomas, endometrial polyps, intrauterine adhesions, and congenital Mullerian anomaly in patients undergoing ovarian stimulation for ART has been reported to vary from 21 to 56 %

Therefore, diagnosis and treatment of intrauterine disease becomes necessarybefore performance of assisted reproductive techniques (ART)

In general, hysterosalpingography (HSG), transvaginal sonography (TVS), sonohysterography, or hysteroscopy are performed to detect such lesions as well as other disease of the female genital system.

The advantage of hysteroscopy is that it offers the opportunity not only of diagnosis but also therapy in the same session, under direct view.

Currently, hysteroscopy is recommended only when an abnormal intrauterine finding is detected via TVS or HSG to confirm the diagnosis and remove the lesion.In addition, hysteroscopy follows inmost cases after repeated ART failures.

In as much as some research studies have reported a substantial increase in the pregnancy rate in infertile women after ART when intrauterine abnormalities have been previously detected and treated during hysteroscopy.

while other clinical trials did not show an increase in implantation and live birth rate.

2014 a retrospective study

2014 a RCT

2014 A PROSPECTIVE COHORT STUDY

2014 A Prospective study

2014 a RCT

CONCLUSION;As an invasive procedure, hysteroscopy is recommended before ART cycles and for confirmation and treatment of doubtful endometrial disease but not as a routine infertility evaluation.

Role of Hysteroscopy in Diagnosis and Treatment of Infertility Factors M.E.Parsanezhad M.D Professor...

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