Hysteroscopy as a Primary Tool in Exploration and Treatment of Infertility: Single Center Experience in Western Romania

(1) Background: Infertility is a disease that affects millions of individuals worldwide. Intrauterine lesions are common in infertile women, hysteroscopy being considered the gold standard for assessing them, even if in routine clinical practice indirect imaging techniques are the first-line investigative tools. The aim of the study was to evaluate hysteroscopic findings among women with unexplained infertility and to analyze fertility outcomes after operative hysteroscopy; (2) Methods: a retrospective cohort study was conducted among 198 women with infertility that had undergone hysteroscopy as the first step of their infertility workup. (3) Results: The median age of the participants was 34 years, 67.7% of them being diagnosed with primary infertility. The most common abnormalities were endometrial polyps, uterine synechiae and uterine fibroids. In addition, pregnancy rates were 23.1% after hysteroscopic polypectomy, 11.1% after hysteroscopic myomectomy and 23.8% after uterine synechiae resection; (4) Conclusions: Endometrial polyps were the most common uterine abnormality found in women with infertility. Hysteroscopic interventions appeared to increase pregnancy rates and outcomes among these women.

Hysteroscopy, the Window into the Uterine Cavity

Hysteroscopy, is a technique by which we can look into the uterine cavity entering through the cervix and is today the most applied minimally invasive technique in Gynecology. Indications for hysteroscopy include infertility investigation, abnormal uterine bleeding, and evaluation of suspicious sonographic findings. Nowadays we approach the uterus via vaginoscopy with no anesthetic. Once inside the uterus, we remove polyps or stringless IUD and take a biopsy. These procedures are often referred as “see and treat”. Operative hysteroscopy under GA or sometimes cervical block, uses larger instruments to resect myomas, cut a septum (metroplasty) or separate intrauterine adhesions (Asherman’s). As Glycine is no more used in hysteroscopy it has become quite a safe procedure. Use of disposable scopes will enable this tool to be part of every gynecologic clinic.

Symptoms and Quality of Life Changes after Hysteroscopic Treatment in Patients with Symptomatic Isthmocele—Preliminary Results

Due to an increasing number of cesarean section deliveries, the common consequences of that surgery are observed more often in the population. One of them is the uterine cesarean scar defect known as niche or isthmocele. Most patients with that aliment are asymptomatic, but some of them can report abnormal uterine bleeding, pelvic pain, subfertility which can be the reason for reduced quality of life (QoL) of the patients. In our study, we analyzed the subjective feelings of changes in the severity of symptoms and quality of life of women with niche after diagnostic and operative hysteroscopy. The patients n = 85 included in the study group completed a follow up questionnaire six months after the procedure. Patients after operative hysteroscopy in comparison to patients after diagnostic procedure reported statistically significant reduction in post-menstruation bleeding/spotting and improvement in the quality of sexual activity. We have also noticed a higher pregnancy rate in the operative group, however, the difference was not statistically significant. According to our study, most women reported a positive effect of hysteroscopy on their QoL in social, psychological, environmental, and health domains.

A clinical audit of hysteroscopy in a tertiary care teaching. What challenges did we face?

Background: The aim of the study was to evaluate indications, operative findings and complications in patients undergoing hysteroscopy.Methods: The data of all patients who underwent hysteroscopy in the department of obstetrics and gynecology in a tertiary care teaching hospital were included retrospectively from November 2017 to October 2018.Results: There were 59 patients who had hysteroscopy for various indications. Twelve patients and forty-seven patients were subjected to diagnostic and operative hysteroscopy respectively. Indications for diagnostic hysteroscopy were for postmenopausal bleed (3), carcinoma of the breast on tamoxifen with bleeding PV (3), recurrent implantation failure (6). Operative hysteroscopy was performed for endometrial polyp (30), myomectomy (9), septal resection (7), copper T removal (1). Complications of hysteroscopy were: media efflux and poor visualization in 10 (17%), minor hemorrhage (9) 15.1%, perforation 2 (3.3%). Minor hemorrhage was managed with tranexamic acid. The perforation in two patients happened during the dilatation of the cervix with metal dilators.Conclusions: One of the major challenges encountered was the efflux of the distension media due to excessive cervical dilatation, which did not provide satisfactory hysteroscopic view. Another complication was perforation during cervical dilatation using Hegars dilator. Use of misoprostol and the use of small sheath hysteroscopes have minimized the need for cervical dilatation.

Two cases of angular pregnancy with incomplete abortion treated with hysteroscopy: a case report and review of literature

Background Angular pregnancy is characterized as implant medial to the uterotubal junction in lateral angular of uterine. It was a rare obstetric complication with severe complications like uterine rupture and retained placenta. Case presentation We report a case of 2 incomplete aborted angular pregnancy that was diagnosed and treated with hysteroscopy. In this case, both of patient were performed operative hysteroscopy for incomplete abortion, and with the assistance of hysteroscopy, the angular pregnancy was detected. Conclusions Hysteroscopy can more intuitively display the conditions inside the uterine cavity, reduce the intraoperative and postoperative complications, and shorten the hospitalization time of patients. During hysteroscopy, angular pregnancy can be visualized in the upper lateral side of the uterine cavity. Based on the investigation results of clinical cases, this is the first case report of hysteroscopy in the treatment of incomplete aborted angular pregnancy.