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

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Role of Hysteroscopy in Diagnosis and Treatment of Infertility Factors M.E.Parsanezhad M.D Professor and chair Department of Gynecology & Obstetrics Head: Reproductive Medicine & Infertility Division E.Mail: [email protected] Shiraz University of Medical Sciences Tehran UMS, Congress 2014. Tehran IRAN
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Page 1: Role of Hysteroscopy in Diagnosis and Treatment of Infertility Factors M.E.Parsanezhad M.D Professor and chair Department of Gynecology & Obstetrics Head.

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: [email protected]

Shiraz University of Medical Sciences

Tehran UMS, Congress 2014. Tehran IRAN

Page 2: Role of Hysteroscopy in Diagnosis and Treatment of Infertility Factors M.E.Parsanezhad M.D Professor and chair Department of Gynecology & Obstetrics Head.

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.

Page 3: Role of Hysteroscopy in Diagnosis and Treatment of Infertility Factors M.E.Parsanezhad M.D Professor and chair Department of Gynecology & Obstetrics Head.

INTRODUCTIION

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

Page 4: Role of Hysteroscopy in Diagnosis and Treatment of Infertility Factors M.E.Parsanezhad M.D Professor and chair Department of Gynecology & Obstetrics Head.

Hysteroscopy & Infertility

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

Page 5: Role of Hysteroscopy in Diagnosis and Treatment of Infertility Factors M.E.Parsanezhad M.D Professor and chair Department of Gynecology & Obstetrics Head.

Hysteroscopy & Infertility

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

Page 6: Role of Hysteroscopy in Diagnosis and Treatment of Infertility Factors M.E.Parsanezhad M.D Professor and chair Department of Gynecology & Obstetrics Head.

Hysteroscopy & Infertility

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

Page 7: Role of Hysteroscopy in Diagnosis and Treatment of Infertility Factors M.E.Parsanezhad M.D Professor and chair Department of Gynecology & Obstetrics Head.

Hysteroscopy & Infertility

Hysteroscpy Before ART?

Page 8: Role of Hysteroscopy in Diagnosis and Treatment of Infertility Factors M.E.Parsanezhad M.D Professor and chair Department of Gynecology & Obstetrics Head.

Hysteroscopy & Infertility

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.

Page 9: Role of Hysteroscopy in Diagnosis and Treatment of Infertility Factors M.E.Parsanezhad M.D Professor and chair Department of Gynecology & Obstetrics Head.

Hysteroscopy & Infertility

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 %

Page 10: Role of Hysteroscopy in Diagnosis and Treatment of Infertility Factors M.E.Parsanezhad M.D Professor and chair Department of Gynecology & Obstetrics Head.

Hysteroscopy & Infertility

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

Page 11: Role of Hysteroscopy in Diagnosis and Treatment of Infertility Factors M.E.Parsanezhad M.D Professor and chair Department of Gynecology & Obstetrics Head.

Hysteroscopy & Infertility

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.

Page 12: Role of Hysteroscopy in Diagnosis and Treatment of Infertility Factors M.E.Parsanezhad M.D Professor and chair Department of Gynecology & Obstetrics Head.

Hysteroscopy & Infertility

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

Page 13: Role of Hysteroscopy in Diagnosis and Treatment of Infertility Factors M.E.Parsanezhad M.D Professor and chair Department of Gynecology & Obstetrics Head.

Hysteroscopy & Infertility

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.

Page 14: Role of Hysteroscopy in Diagnosis and Treatment of Infertility Factors M.E.Parsanezhad M.D Professor and chair Department of Gynecology & Obstetrics Head.

Hysteroscopy & Infertility

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.

Page 15: Role of Hysteroscopy in Diagnosis and Treatment of Infertility Factors M.E.Parsanezhad M.D Professor and chair Department of Gynecology & Obstetrics Head.

Hysteroscopy & Infertility

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

Page 16: Role of Hysteroscopy in Diagnosis and Treatment of Infertility Factors M.E.Parsanezhad M.D Professor and chair Department of Gynecology & Obstetrics Head.
Page 17: Role of Hysteroscopy in Diagnosis and Treatment of Infertility Factors M.E.Parsanezhad M.D Professor and chair Department of Gynecology & Obstetrics Head.

2014 a retrospective study

Page 18: Role of Hysteroscopy in Diagnosis and Treatment of Infertility Factors M.E.Parsanezhad M.D Professor and chair Department of Gynecology & Obstetrics Head.

2014 a RCT

Page 19: Role of Hysteroscopy in Diagnosis and Treatment of Infertility Factors M.E.Parsanezhad M.D Professor and chair Department of Gynecology & Obstetrics Head.
Page 20: Role of Hysteroscopy in Diagnosis and Treatment of Infertility Factors M.E.Parsanezhad M.D Professor and chair Department of Gynecology & Obstetrics Head.
Page 21: Role of Hysteroscopy in Diagnosis and Treatment of Infertility Factors M.E.Parsanezhad M.D Professor and chair Department of Gynecology & Obstetrics Head.

2014 A PROSPECTIVE COHORT STUDY

Page 22: Role of Hysteroscopy in Diagnosis and Treatment of Infertility Factors M.E.Parsanezhad M.D Professor and chair Department of Gynecology & Obstetrics Head.

2014 A Prospective study

Page 23: Role of Hysteroscopy in Diagnosis and Treatment of Infertility Factors M.E.Parsanezhad M.D Professor and chair Department of Gynecology & Obstetrics Head.

2014 a RCT

Page 24: Role of Hysteroscopy in Diagnosis and Treatment of Infertility Factors M.E.Parsanezhad M.D Professor and chair Department of Gynecology & Obstetrics Head.

Hysteroscopy & Infertility

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.


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