Hysteroscopic Management of Intrauterine Pathologies: A Case Series of 296 Patients

2017 ◽  
Vol 5 (1) ◽  
pp. 35-40
Author(s):  
Rahul Manchanda ◽  
Charu Pathak ◽  
Garima Yadav
Keyword(s):  
Case Series ◽  
Uterine Cavity ◽  
Postmenopausal Bleeding ◽  
Secondary Infertility ◽  
Diagnostic Modality ◽  
Endometrial Polyps ◽  
Detection Rates ◽  
Primary Infertility ◽  
Endocervical Canal ◽  
Infertility Patients

ABSTRACT Aims To discuss the incidence of various hysteroscopic findings in patients of infertility, abnormal uterine bleeding (AUB), and postmenopausal bleeding and to compare the prevalence of various uterine pathologies in patients of primary and secondary infertility. Materials and methods This is a retrospective observational study, which evaluated 296 patients who underwent diagnostic hysteroscopy for evaluation of primary or secondary infertility, AUB, and postmenopausal bleeding over a period of 18 months in a Gynae-endoscopy Unit. Detailed hysteroscopic evaluation of the endocervical canal and uterine cavity in all recruited cases was done by the same surgeon and the data were collected by reviewing the case records. Results Among the 296 cases analyzed, 157 cases were of primary infertility, 81 cases were of secondary infertility, 45 cases were of AUB, and 13 cases presented with postmenopausal bleeding. Among the primary infertility patients, 58.6% had abnormal findings on hysteroscopy, while among the secondary infertility patients, hysteroscopy revealed abnormalities in as high as 72.5% cases. In the present study, uterine synechiae was the most common abnormality detected among the infertile patients. Endometrial polyps were the most common pathology detected among patients with AUB and postmenopausal bleeding. Conclusion Hysteroscopy is a minimally invasive and highly safe technique to directly visualize the endocervical canal, uterine cavity, and tubal ostia. It has an added advantage of treating the pathology in the same sitting, thus improving the clinical outcomes. Based on our findings, we conclude that uterine pathologies are a major contributor in causing infertility and menstrual irregularities, which are missed on blind modalities like hysterosalpingography and dilatation and curettage. Clinical significance This article stresses on the use of hysteroscopy as a primary diagnostic modality in evaluating patients of infertility, AUB, and postmenopausal bleeding in order to increase the detection rates of uterine pathologies. How to cite this article Yadav G, Manchanda R, Pathak C. Hysteroscopic Management of Intrauterine Pathologies: A Case Series of 296 Patients. J South Asian Feder Menopause Soc 2017;5(1):35-40.

scholarly journals Hysteroscopic evaluation in infertility and abnormal uterine bleeding

2018 ◽  
Vol 7 (2) ◽  
pp. 612
Author(s):  
Navneet Kaur ◽  
Ruby Bhatia ◽  
Paramjit Kaur ◽  
Surinder K. Bhopal
Keyword(s):  
Endometrial Hyperplasia ◽  
Uterine Cavity ◽  
Invasive Procedure ◽  
Abnormal Uterine Bleeding ◽  
Endometrial Biopsy ◽  
Uterine Bleeding ◽  
Therapeutic Modality ◽  
Secondary Infertility ◽  
Endometrial Polyps ◽  
Submucous Fibroid

Background: Hysteroscopy an endoscopic procedure for visualization of uterine cavity may be extensively used in both primary and secondary infertility and abnormal uterine bleeding for evaluating intrauterine pathology. The objectives of this study were to visualize and identity intrauterine pathology in both primary and secondary infertility and abnormal uterine bleeding (AUB) by hysteroscopic evaluation and to perform hysteroscopic guided therapeutic procedures like endometrial currettage, polypectomy, adhesiolysis.Methods: Hysteroscopic evaluation of uterine cavity for any intrauterine pathology in AUB and Infertility. Adhesiolysis, polypectomy, endometrial biopsy misplaced copper T removal were carried out under hysteroscopic vision.Results: Intrauterine synechia in 20.51%, Submucous fibroid in 5.13%, bicornuate uterus, endometrial hyperplasia and endometrial polyp were seen in 2.56% patient each were detected in infertility group while 81.95% cases with AUB had abnormal intrauterine pathology commonest being endometrial hyperplasia in 33.33% followed by endometrial polyps in 23.81% cases, submucous fibroid and misplaced copper T in 9.52% each and intrauterine synechia in 4.76% patient. Endometrial biopsy and polypectomy was done in 23.80% each with AUB, misplaced copper T removal in 9.52% and adhesiolysis in 4.76% patient with AUB.Conclusions: Hysteroscopy remains gold standard for evaluating intrauterine lesions in abnormal uterine bleeding and infertility. A safe, simple minimally invasive procedure not only diagnostic but therapeutic modality for adhesiolysis, endometrial biopsy/curettage, polypectomy, misplaced copper T removal under direct vision with minimal complication within reach of every Gynaecologist thereby reducing burden of major surgical intervention.

Hysteroscopy

2020 ◽  
pp. 597-606
Author(s):  
O. A. O’Donovan ◽  
Peter J. O’Donovan
Keyword(s):  
Gold Standard ◽  
Uterine Cavity ◽  
Direct Visualization ◽  
Postmenopausal Bleeding ◽  
Endometrial Polyps ◽  
Current State ◽  
Technological Advances ◽  
Wide Range ◽  
Proper Training ◽  
Low Incidence

Hysteroscopy (direct endoscopic visualization) of the endometrial cavity is an exciting and rapidly developing field of gynaecological practice. The most dramatic advances have occurred during the last 20 years due to technological advances including miniaturization of equipment and improved optics. Hysteroscopy is used both diagnostically and therapeutically to treat a wide range of gynaecological problems (heavy menstrual bleeding, infertility, and postmenopausal bleeding). The most recent advances allow accurate direct visualization of the uterine cavity which provides a platform for targeted biopsies, safe removal of endometrial polyps, and treatment of fibroids, septa, and adhesions. Proper training has resulted in a low incidence of serious complications. The current consensus is that hysteroscopy provides a gold standard not only for evaluating and treating intrauterine pathology but also for allowing a minimalist approach which has resulted in improved patient outcomes. This chapter provides an overview of the current state of this exciting and evolving field.

scholarly journals Hysterosalpingography Findings and Jimah Ratio of the Uterine Cavity in Women with Infertility in Central Region, Ghana

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Bashiru Babatunde Jimah ◽  
Philip Gorleku ◽  
Anthony Baffour Appiah
Keyword(s):  
Central Region ◽  
Acute Infection ◽  
Significant Proportion ◽  
Uterine Cavity ◽  
Fallopian Tubes ◽  
Cape Coast ◽  
Secondary Infertility ◽  
Diagnostic Modality ◽  
Cross Sectional ◽  
Infertile Women

Background. Infertility affects from 1.3% to 25.7% of couples worldwide and, especially, from 14.5% to 16.4% in Africa. Hysterosalpingography (HSG) is a diagnostic modality that is considered both common and efficient. It is used to investigate abnormalities of the uterine cavity and fallopian tubes. This study assessed the spectrum of findings on HSG among women with infertility in the Central Region (Ghana). Methods. We conducted a prospective cross-sectional study to examine 203 infertile women undergoing HSG work-up at the Cape Coast Teaching Hospital. The exclusion criteria were acute infection of the vagina or cervix and active vaginal bleeding or pregnancy. Data were entered with Microsoft Excel and analyzed using SPSS version 21. Results. A total of 203 women were enrolled, and eighty-five (41.87%) of the women had at least one or more abnormalities. The mean age was 32.9 years with majority of the women within 30–39 years (61.08%). More than half (50.74%) of the women presented with secondary infertility, while age of women ( p = 0.004 ) and duration of infertility (0.034) were found to be in association with the type of infertility. Uterine findings were predominantly capacious uterine cavity (45.1%) and uterine fibroids (33.3%), while fallopian tube findings included bilateral blockage (24.2%), right unilateral proximal blockage (17.7%), loculated spillage (16.1%), and left unilateral proximal blockage (16.1%). The range of normal uterine cavity size, measured as ratio (Jimah ratio) of intercornual diameter to interiliac diameter was 0.2–0.45, with a mean of 0.36. Conclusion. Secondary infertility was the commonest indication for HSG in the study, and a significant proportion of infertile women had abnormalities. Abnormalities were higher in the fallopian tubes than the uterus, while capacious uterine cavity, uterine fibroid, and bilaterally blocked tubes were the top three abnormalities found.

scholarly journals Is hysterolaparoscopy a real theranostic approach for anatomical barriers in female fertility? A future argument

2018 ◽  
Vol 7 (6) ◽  
pp. 2423
Author(s):  
Namita Agrawal ◽  
Poonam Yadav ◽  
S. Fayyaz ◽  
Brinderjeet Kaur
Keyword(s):  
Real Time ◽  
Female Fertility ◽  
Therapeutic Interventions ◽  
Secondary Infertility ◽  
Female Patients ◽  
Primary Infertility ◽  
Diagnostic Work ◽  
Infertility Patients ◽  
Work Up ◽  
Diagnostic Work Up

Background: Hysterolaparoscopy is a modality that provides the real time abdomino-pelvic view during diagnosis in infertile female patients and any pathology is noticed can be tackled at the same time. So we investigate the theranostic application of hysterolaparoscopy in structural causes of female infertility in present study.Methods: Authors prospectively evaluate 157 female patients (mean age 27.7 years) diagnosed as infertile, underwent hysterolaparoscopy during diagnostic work-up.  All the enlisted patients fulfilled the criteria of infertility. The noticed anatomical abnormalities in the hysterolaparoscopy were tackled at the same time if possible.Results: Of the 157 infertile female patients, 93 (~59.2%) were of primary infertility and remaining 64 (~41.8%) were secondary infertility patients. Hysterolaparoscopy showed abnormalities in 125/157 (~85.0%) patients. The detected hysterolaparoscopic abnormalities were distributed in 77/93 (~82.8%) primary and 48/64 (~75.0%) secondary infertility patients. Of the 125 patients with abnormal hysterolaparoscopic findings, 121 (~96.8%) experienced for active therapeutic interventions. All of the 48 secondary infertility patients with hysterolaparoscopic abnormalities experienced for active hysterolaparoscopic interventions. Of 77 patients with hysterolaparoscopic abnormality in primary infertility group, 73 (~94.8%) experienced active intervention. Only four patients with streak ovaries and hypoplastic uterus, few tiny fibroids and adenomyosis did not undergo for active hysterolaparoscopic intervention.Conclusions: Authors concluded that hysterolaparoscopy has a better theranostic approach for the anatomical barriers of female fertility so it can be performed in the initial phases of the infertility diagnostic work-up.

scholarly journals Evaluation of the uterine cavity by office hysteroscopy in patients with infertility and recurrent pregnancy loss: a cross sectional study

2018 ◽  
Vol 8 (1) ◽  
pp. 200
Author(s):  
Abo Bakr A. Mitwally ◽  
Esraa Y. Badran ◽  
Tamer Arby ◽  
Ahmed M. Abbas ◽  
Ahmed Nasr ◽  
...  
Keyword(s):  
Pregnancy Loss ◽  
Recurrent Pregnancy Loss ◽  
Transvaginal Ultrasound ◽  
Uterine Cavity ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Office Hysteroscopy ◽  
Secondary Infertility ◽  
Cross Sectional ◽  
Endometrial Polyps

Background: The aim of the present study is to determine role of hysteroscopy in women presented with primary or secondary infertility and in women presented with recurrent pregnancy loss.Methods: This cross-sectional study was conducted at Obstetrics and Genecology Department, Women Health Hospital Assiut University, Egypt from October 2016 to February 2018. Reproductive aged women who are suspected as having intrauterine pathology, such as submucosal myoma, endometrial polyps or other endometrial pathological findings based on the transvaginal ultrasound were enrolled. All patients were scheduled for office hysteroscopy as an outpatient. An informed consent was obtained prior to participation in the study.Results: Hysteroscopy was performed in 139 infertile women and 41 cases of repeated pregnancy loss. With regard to infertile patients; 67.6% of the patients had normal findings, 10.1% of the patients had intrauterine adhesion, 8.6% of the patients had intrauterine polyp. 5.8% of the patients had septate uterus and 3.6% of the patients had depressed fundus. With regard to patients with recurrent pregnancy loss; 51.2% of the patients had normal findings, 21.9% of the patients had partial septum, 9.8% of patients had intrauterine adhesions, 7.3% of patients had intrauterine polyp and 4.9% of the patients had submucous myoma.Conclusions: It was concluded that hysteroscopy should be considered as routine investigation in evaluation of women with primary and secondary infertility.

scholarly journals Assessment of depression, anxiety and stress among Indian infertile couples in a tertiary health care centre in Bihar

2020 ◽  
Vol 9 (2) ◽  
pp. 659
Author(s):  
Kalpana Singh ◽  
Kumari Shashi ◽  
Kumari Rajshee ◽  
Shivani Sinha ◽  
Geetam Bharti
Keyword(s):  
Quality Of Life ◽  
Mental Health Problems ◽  
Public Healthcare ◽  
Secondary Infertility ◽  
Health Care Centre ◽  
Primary Infertility ◽  
Infertile Couples ◽  
Infertility Patients ◽  
Infertile Patients

Background: Infertility rate is on rising trend. It is often associated with a chronic state of stress which may manifest itself in anxiety-related and depressive symptoms. Also, the affected family faces social discrimination, ostracism and stigma which leads to increased anxiety or depression among infertile couples. The motive of this study was to assess the quality of life among infertile couples; to determine the relationship between various domains of quality of life of infertile couples i.e. emotional, mind/body, relational, social, environmental and tolerability and to determine the association of levels of quality of life of infertile couples with the selected variables visiting  IGIMS.Methods: This was a cross-sectional based study; carried out in the department of reproductive medicine, IGIMS, Patna, Bihar for one-year duration (January 2017 to December 2017), on 122 infertile patients attending outpatient department for treatment. Data was collected by using self-administered questionnaire i.e. Ferti QoL questionnaire and HADS.Results: Among all these 96 cases was found to be suffering from primary infertility and 26 cases from secondary infertility. In primary infertile patient social domain was the most affected domain having the greatest impact on their quality of life. In secondary infertile patients the tolerability domain was the most affected domain having the greatest impact on their quality of life. The total fertility quality of life score in primary infertility patients showed a lesser quality of life (55.41) than secondary infertility patients (66.29).Conclusions: This study points at the necessity of specific psychological interventions, presently absent from the public healthcare routine, for women struggling with infertility, to help them manage potential mental health problems and meet their reproductive goals.

scholarly journals Observational study of HSG with laparoscopic correlation in infertility patients

2018 ◽  
Vol 7 (5) ◽  
pp. 1903
Author(s):  
Avinash Dubbewar ◽  
Saumen Kanti Nath
Keyword(s):  
Predictive Value ◽  
Pregnancy Loss ◽  
Diagnostic Laparoscopy ◽  
High Sensitivity ◽  
Secondary Infertility ◽  
Tubal Patency ◽  
Primary Infertility ◽  
Appropriate Therapy ◽  
Infertility Patients ◽  
Recurrent Early Pregnancy Loss

Background: Uterine abnormalities contribute to 10% of infertility cases and 50% of women with recurrent early pregnancy loss whereas fallopian tube abnormalities contribute to 20% of such cases.Methods: Total 61 patients of infertility and subfertility undergoing evaluation and treatment at our centre were selected for HSG. Total 25 patients from this group have undergone diagnostic laparoscopy, their findings were correlated with HSG findings retrospectively.Results: All the patients in the study group were either primary or secondary infertility patients. Of the 61 patients of infertility, 49 were in primary infertility group and 12 were in secondary infertility group. The age of patients was between 23 and 35 years. The average duration of primary infertility was 5 years and secondary infertility was 3.5years. Total 61 patients underwent HSG, 42(68.8%) patients had normal findings and 19(31.14%) patients had abnormal findings. In abnormal findings 4(6.55%) were Mullerian abnormalities and 15(24.59%) were either unilateral or bilateral tubal block. Total 25 patients underwent diagnostic laparoscopy out of 61 patients. The sensitivity of HSG was 90% and specificity was 60 % with positive predictive value of 60% and negative predictive value of 90% as compared to diagnostic laparoscopy. Tubal block was defined as any form of tubal occlusion detected at HSG and finally confirmed on laparoscopy.  In our laparoscopy findings, peri-adnexal adhesions were found in 5 (20%) of the blocked tubes on laparoscopy. Endometriosis was detected in 1 (4%) of the blocked tubes and suspected intra-tubal block in 2 (8%).Pelvic inflammatory disease was found to contribute in 3 (12%).Conclusions: HSG demonstrates high sensitivity in our study. So, it should be used as the initial investigation for identifying uterine abnormality and tubal patency. As the specificity is less, we suggest that laparoscopy is necessary to recognize those cases of tubal block, which were unrecognized or wrongly recognized on HSG. In addition, the patients who were found to have tubal block on HSG, laparoscopy helps in finding the cause of infertility like existence of peritubal adhesions and endometriosis that can guide appropriate therapy. 

scholarly journals Evaluation of infertility in women from an industrial area in Telangana, India by diagnostic hysterolaparoscopy: can it explain the unexplained?

2018 ◽  
Vol 7 (6) ◽  
pp. 2164
Author(s):  
Leena Kanungo ◽  
Mylavarapu Haritha ◽  
Nerakh Chaitanya ◽  
Katroth Sangeetha
Keyword(s):  
Transvaginal Ultrasound ◽  
Industrial Area ◽  
Industrial Workers ◽  
Secondary Infertility ◽  
Diagnostic Modality ◽  
Primary Infertility ◽  
Toxin Exposure ◽  
Diagnostic Hysteroscopy ◽  
A Prospective Study ◽  
Tubal Pathology

Background: Infertility with a prevalence of 10-15% worldwide has been showing a rising trend. Diagnostic hysterolaparoscopy (DHL) procedure in infertility cases uncovers conditions which even a detailed clinical examination or hysterosalpingography or transvaginal ultrasound can miss. Correction of these factors improves chances of conception, naturally or by subsequent ART procedures.Methods: This is a prospective study conducted from January 2014 to December 2015. The objective of this study is to evaluate the factors causing infertility by diagnostic hystertolaparoscopy among primary and secondary infertility women coming from an industrial area, attending infertility clinic at Employees State Insurance Corporation Hospital, Telangana. 80 cases of primary infertility (65%)and secondary infertility (35%) belonging to age group of 19 to 35 years and above, satisfying the inclusion criteria underwent a systematic way of evaluation by diagnostic hysteroscopy followed by diagnostic laparoscopy procedure.Results: 40.38% of primary infertility and 35.72% of secondary infertility had abnormal pelvic pathology. 27% of primary and 32.14% of secondary infertility had abnormal intrauterine abnormality. Diagnostic hysteroscopy found intrauterine septum and endometrial polyp in 12.5% and tubal ostial fibrosis in 5% of total cases. Pelvic peritoneal adhesion (23.75%), pelvic endometriosis (13.75%) and tubal pathology (18.75%) were most common laparoscopic findings. 32.5% of all cases had no significant abnormality. Bilateral tubal block was seen in 20% of cases on chromopertubation. DHL also facilitated operative interventions like adhesionolysis, endometriotic tissue ablation, ovarian cyst drilling, septal resection, polypectomy in the same sitting.Conclusions: DHL procedure has become the gold standard diagnostic modality, as it explains 30-70% of factors that remained undetected during routine investigative workup of female infertility, especially those grouped under unexplained infertility. Industrial toxin exposure may lead to infertility as this study among industrial workers showed a greater incidence of tubo-peritoneal pathology than other factors.

scholarly journals Hysterosalpingographic Evaluation of Uterus and Fallopian Tubes of Infertile Women

2017 ◽  
Vol 6 (1) ◽  
pp. 63-71 ◽  
Author(s):  
Manoj Bhattarai ◽  
Sita Pokhrel Ghimire
Keyword(s):  
Fallopian Tube ◽  
Uterine Cavity ◽  
Categorical Variables ◽  
P Value ◽  
Fallopian Tubes ◽  
Secondary Infertility ◽  
Radiological Investigation ◽  
Infertile Women ◽  
Primary Infertility ◽  
Significant Difference

Background: Hysterosalpingography (HSG) is a routinely performed radiological investigation for evaluation of uterine cavity morphology and fallopian tube patency in infertile women. This study was undertaken to describe patterns of HSG findings and to assess any significant difference in uterine and fallopian tube findings in women with primary and secondary infertility in eastern part of Nepal.Material and Methods: Hospital based cross sectional descriptive study was conducted by retrospectively analyzing HSG records of 216 infertile women (both primary and secondary infertility) done from April 2014 to August 2016. Radiological findings in uterus and fallopian tubes were recorded and analyzed. Association between two categorical variables was examined by Chi-square test.Results: Majority of infertile women (53.2%) had primary infertility. Abnormal HSG was seen in 44.9% infertile women and higher in secondary infertility (57.4%) than with primary infertility (33.9%) (OR = 2.63, 95% CI = 1.51 – 4.57, P value = 0.001). Tubal abnormality was common than uterine abnormality (36.1% versus 8.8%, P value= 0.001). Tubal abnormalities were higher in women with secondary infertility than with primary infertility (52.5% versus 21.7%), whereas uterine abnormalities were common with primary infertility compared to secondary infertility (12.2% versus 5.0%) (P value= 0.001).Conclusion: Abnormal HSG was more associated with secondary infertility. Infertility was significantly associated with tubal abnormality than with uterine abnormality. Tubal abnormalities are common in women with secondary infertility whereas uterine abnormalities are common in women with primary infertility and are statistically significant.Journal of Nobel Medical CollegeVolume 6, Number 1, Issue 10 (January-June, 2017), Page: 63-71

scholarly journals Laparoscopy: the tool for infertility

2017 ◽  
Vol 6 (12) ◽  
pp. 5544
Author(s):  
Neelima P. Shah ◽  
Prashant D. Shah
Keyword(s):  
Blue Dye ◽  
Secondary Infertility ◽  
Tubal Patency ◽  
Infertile Women ◽  
Primary Infertility ◽  
Therapeutic Laparoscopy ◽  
Therapeutic Value ◽  
Ovarian Pathology ◽  
Infertility Patients

Background: Most of the healthy couples conceive within a year after marriage. The infertility patients have become important part of clinical practice. Diagnostic and therapeutic Laparoscopy plays major role in the management of these cases. We investigated hale 50 infertile women with laparoscopy. This study was undertaken to ascertain the diagnostic and therapeutic role of Laparoscopy in female infertility.Methods: We evaluated 50 couples having infertility. The cases of primary and secondary infertility were evaluated. The laparoscopy was done under general anaesthesia. The pelvic organs were examined, and tubal patency was tested with chromo-perturbation by using Methylene blue dye. The findings were noted. The therapeutic intervention was done in the cases where it was necessary.Results: Total 50 cases of infertility were studied. Thirty were of primary infertility and 20 were of secondary infertility. The patients with primary infertility were younger with mean age of 20 years. The duration of infertility ranged from 1.5 to 8 years. We detected total 21 (42%) patients with ovarian pathology, 5 (10%) with tubal, four (8%) with peritoneal factor 3 (6%) with endometriosis. One patient had uterine fibroid and 16 (32%) cases had normal laparoscopic findings.Conclusion: This study supported the diagnostic and therapeutic value of laparoscopy in managing infertile women. It helped in detection of pelvic pathology. It also helped to plan further management in the form of IUI or IVF.

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