Hysteroscopic Detection of Intrauterine Pathology in Women with Unexplained Infertility

Abstract
Background: Abnormalities of the uterus are relatively uncommon cause of infertility but should be considered, if no other reason, they can adversely affect the outcome of pregnancies achieved by successful treatment. The anatomic uterine abnormalities that may adversely affect fertility include congenital malformations, leiomyoma's, intrauterine adhesions, and endometrial polyps, but their reproductive implications are most unclear. One of the basic steps of an infertility workup is to evaluate the shape and regularity of the uterine cavity. Acquired uterine lesions, such as uterine fibroids, endometrial polyps, intrauterine adhesions, or all of these, may cause infertility by interfering with proper embryo implantation and growth. Congenital uterine malformations are also thought to play a role in delaying natural conception
Aim of Study: This study was designed to evaluate the role of hysteroscopy in women with unexplained infertility.
Patients and Methods: Women with unexplained infertility were included in this cross sectional study, evaluated with transvaginal sonography and diagnostic hysteroscopy. Diag-nostic hysteroscopy was performed between the 7th and 11th day of the cycle. The criteria for hysteroscopic findings were based on the cervical canal, uterine cavity, endometrium, visualization of the tubal ostium and lesions of the utero-tubal junction. Patients were classified according to the hysteroscopy results into two groups: Patients with no abnormality detected (n=49), patients with uterine abnormalities (n=71).
Results: One hundred twenty women with unexplained infertility were included, all patients underwent diagnostic hysteroscopy. Based on hysteroscopic findings, 22 of them (18.3%) were finally diagnosed to have polyps, 6 patients had cervical stenosis (5%), 1 patients have myomas (.8%), 8 patients had intrauterine synechia (7%) and 19 patients had congenital uterine anomalies (16%). Cervicitis was found in 12 cases (10%), while 3 cases had endocervical cysts (2.5%), cornu not accessible in 4 cases (3.3%), while ostia not seen in 8 cases (6.6%), 3 cases had tight isthmus (2.5%) and 3 cases had polypidal thickness at isthmus (2.5%) while hyster-oscopy results were found to have no abnormality in 49 patients (40.8%).
Conclusions: Routine hysteroscopy should be used as a basic part of the work-up for women with unexplained infer-tility.