ANALYSIS OF THE DETECTION OF ABNORMAL HYSTEROSCOPIC FINDINGS IN WOMEN WITH INFERTILITY

Abstract

The state of health of the mother’s body and directly of the uterine cavity, which is the place of the fi rst meeting of the embryo and the pregravid endometrium, are extremely important for the normal development of the fertile egg. Abnormalities of the uterine cavity can be the cause of infertility in 10-15 % of women. Pathology of the uterine cavity is considered one of the leading causes of unsuccessful attempts at additional reproductive technologies (ART), causes of early pregnancy loss. The aim of this study was to analyze hysteroscopic fi ndings in women with infertility based on the results of offi ce hysteroscopy and compare them with uterine pathology detected by ultrasound (US).Material and methods. A retrospective analysis of the medical records of 208 women with infertility who underwent office hysteroscopy and endometrial biopsy was performed. 94 (45.2 %) patients had primary infertility and 114 (54.8 %) had secondary infertility. All women underwent preoperative transvaginal US on a Voluson S8 unit. A 5 mm Bettocchi hysteroscope with a surgical channel was used during the proliferative phase of the menstrual cycle. Examination of the uterine cavity, a bubble test to determine tubal patency, targeted endometrial biopsy with histologic and immunohistochemical studies, and treatment of any pathology detected were performed. A statistical analysis package based on Microsoft Excel and the «Statistica 12.0» program (StatSoft Inc., USA) was used. Patients’ rights were respected in accordance with the Declaration of Helsinki «Ethical Principles of Medical Research InvolvingHuman Subjects» developed by the World Medical Association, «Universal Declaration of Bioethics and Human Rights (UNESCO)». All pregnant women issued «Informed consent to participate in the study.» The study was carried out within the framework of the National Development Program «Improvement of diagnosis and treatment of pregnant women with a burdened somatic history» of the Department of Obstetrics and Gynecology, Faculty of Postgraduate Education, Ternopil National Medical University named after I. Ya. Gorbachevsky, state registration number N 0121U100153, implementationperiod 2021-2023) Results and conclusions. 164 (78.8 %) patients had a normal hysteroscopic picture, 44 (21.2 %) had pathological hysteroscopicfi ndings, among which endometrial polyps predominated in women with primary infertility, and synechiae of the cervical canal and uterine cavity were most frequently found in secondary infertility. The tubal patency test showed a higher frequency of cases of obstruction of both fallopian tubes in primary infertility, while in secondary infertility the tubes were patent in most people. The normal state of the uterus according to US was determined in 174 women, of whom 87.9 % were confi rmed to have no pathological formations, and 12.1 % of them had abnormal hysteroscopic fi ndings. Pathological conditions of the uterus were diagnosed by ultrasound in 34 patients, which was confi rmed by hysteroscopy in 67.6 % of women, in 32.4 % of cases the normal state of the uterus was visualized. The higher value of offi ce hysteroscopy for detection and treatment of uterine cavity pathology in women with infertility compared to transvaginal ultrasound has been proven. The sensitivity of detection of pathological formations in the uterus during hysteroscopy was98.1 %, specifi city of 96.4 %, while the sensitivity of ultrasound of the uterus was 87.9 %, specifi city of 67.6 %. Hysteroscopy should be considered an integral stage in the diagnosis/treatment of infertility both in women with confi rmed uterine pathology by ultrasound and in those without detected abnormalities.