Should hysteroscopy be combined with laparoscopy in endometriosis associated infertility?

Objectives

The aim of this study was to evaluate the uterine cavity in cases of endometriosis associated infertility using office hysteroscopy.

Study design

A retrospective observational analytical study.

Patients and methods

The study conducted on 50 women with endometriosis diagnosed by laparoscopy seeking fertility treatment between December 2013 and October 2015. The study was approved from Ethical committee board of the faculty of Medicine Alexandria University. After explanation of the study objectives and procedures to all eligible women, informed written consent was signed. Thorough history taking, clinical examination and vaginal ultrasound examination was conducted to all participants. Office Hysteroscopy was done in the early proliferative phase using normal saline as a distention medium. All data were pulled from the reports at Elshatby Maternity University Hospital.

Results

The age of the study group was ranging from 20 to 34 years with the mean of 29 years ± 3 years. 42 cases were primary infertility counting for 84% of patients and 8 cases were secondary infertility counting for 16% of patients. This reflects the strong impact of endometriosis on fertility. Normal uterine cavity was diagnosed in 35 cases representing 70% of the studied patients group. 10 cases had endometrial polyps representing 20% of the studied patients group. 5 cases had a uterine septum representing 10% of the studied patients group. 2 cases had a hypo plastic uterus in addition to uterine septum representing 4% of the studied patients group. Normal uterine cavity were diagnosed using hysteroscopy in 63.0% (18/23) in women having ovarian endometrioma while this normality was 78.3% (17/27) in women without endometrioma however, The prevalence of endometrial polyp was 25.9% in cases with endometrioma and 13% in cases without endometrioma. Cases with a uterine septum were 7.4% (2/23) of cases having ovarian endometrioma and 13.0% (3/27) of cases without it. Two cases with endometrioma out of 23 cases were diagnosed to have hypoplastic uterus. No uterine abnormalities were found in stage 1 endometriosis in contrast to the presence of 53.2% of patients with a uterine abnormality in stage 2. Also stage 3 patients were all having a normal uterine cavity while only 72.4% of patients with stage 4.

Conclusion

From the results of this study we can conclude that there is a High prevalence of endometrial polyps in cases of endometriosis. Also there is a High prevalence of uterine anomalies in cases of endometriosis. Still, we neither cannot recommend hysteroscopy as a routine in any endometriosis patient undergoing laparoscopy.