• Women's Health Nursing
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• v.26 no.4
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• pp.300-317
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• 2020

Purpose: Hysteroscopy can be used both to diagnose and to treat intrauterine pathologies. It is well known that hysteroscopy helps to improve reproductive outcomes by treating intrauterine pathologies. However, it is uncertain whether hysteroscopy is helpful in the absence of intrauterine pathologies. This study aimed to confirm whether hysteroscopy improves the reproductive outcomes of infertile women without intrauterine pathologies. Methods: We conducted a systematic review of 11 studies retrieved from Ovid-MEDLINE, Ovid-Embase, and the Cochrane Library. Two independent investigators extracted the data and used risk-of-bias tools (RoB 2.0 and ROBINS-I) to assess their quality. Results: Diagnostic hysteroscopy prior to in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) was associated with a higher clinical pregnancy rate (CPR) and live birth rate (LBR) than non-hysteroscopy in patients with recurrent implantation failure (RIF) (odds ratio, 1.79 and 1.46; 95% confidence interval, 1.40-2.30 and 1.08-1.97 for CPR and LBR, respectively) while hysteroscopy prior to first IVF was ineffective. The overall meta-analysis of LBR showed statistically significant findings for RIF, but a subgroup analysis showed effects only in prospective cohorts (odds ratio, 1.40 and 1.47; 95% confidence interval, 0.62-3.16 and 1.04-2.07 for randomized controlled trials and prospective cohorts, respectively). Therefore, the LBR should be interpreted carefully and further research is needed. Conclusion: Although further research is warranted, hysteroscopy may be considered as a diagnostic and treatment option for infertile women who have experienced RIF regardless of intrauterine pathologies. This finding enables nurses to educate and support infertile women with RIF prior to IVF/ICSI.

• Journal of Yeungnam Medical Science
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• v.22 no.1
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• pp.81-89
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• 2005

Background: Hysteroscopy is considered to be the gold standard not only for visualizing the cervical canal and the uterine cavity, but also for treating many different types of benign pathologies localized to those regions. The advent and evolution of endoscopic imaging and surgery during the last two decades has added new dimensions to the armamentarium of a gynecologist to combat intrauterine lesions. Office hysteroscopy is increasingly being used as a first line investigation for abnormal uterine bleeding and other diseases involving the uterine cavity. The aim of our study is to assess the diagnostic and operative efficacy of office hysteroscopy. Materials and Methods: In our department, 140 patients underwent a hysteroscopy examination and 18 of these underwent an office based hysteroscopy examination from September 1995 to March 2005. The cases who underwent an office based hysteroscopy examination were reviewed in order to assess the clinical usefulness and significance in the management of intrauterine lesions. Results: Major indication was abnormal uterine bleeding(12 cases, 66.7%). The others were a missed IUD and infertility. The hysteroscopic findings were a normal uterine cavity(6 cases, 33.3%), IUD in situ, polyp, submucosal myoma, endometrial hyperplasia and a placenta remnant. Conclusion: Office hysteroscopy is a safe, quick and effective method for making an intrauterine evaluation. In addition, it provides immediate results, offers the capacity of direct targeted biopsies of suspicious focal lesions, and offers the direct treatment of some intrauterine conditions.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.13
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• pp.5355-5358
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• 2014

Background: To assess the role of sonographic endometrial thickness and hysteroscopic polyp size in predicting premalignant and malignant polyps in postmenopausal women. Materials and Methods: A total of 328 postmenopausal women with abnormal uterine bleeding and thickened endometrium underwent operative hysteroscopy due to detection of endometrial polyps were included in this retrospective study. Preoperative endometrial thickness measured by transvaginal ultrasonography and polyp size on hysteroscopy were noted. Hysteroscopic resection with histology was performed for endometrial polyps. Endometrial thickness and polyp size were evaluated on the basis of final diagnosis established by histologic examination. Receiver operator characteristic curves were calculated to assess the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of endometrial thickness and polyp size for detecting pemalignant and malignant polyps. Results: Premalignant and malignant polyps were identified in 26 (7.9%) of cases. Sonographic measurement showed a greater endometrial thickness in cases of premalignant and malignant polyps when compared to benign polyps. On surgical hysteroscopy, premalignant and malignant polyps were also larger. Endometrial thickness demonstrated a sensitivity of 53.8%, specificity of 85.8%, PPV of 24.6% and NPV of 95.6% at a cut-off limit of 11.5 mm with diagnostic accuracy of 83.2%. Polyp size has a diagnostic accuracy of 94.8% with a sensitivity of 92.3%, specificity of 95.0%, PPV of 61.5% and NPV of 99.3% at a cut-off point of 19.5mm. Conclusions: Endometrial thickness measured by transvaginal ultrasonography is not sufficient in predicting premalignant and malignant endometrial polyps in postmenopausal women with abnormal uterine bleeding and thickened endometrium. Polyp size on hysteroscopy is a more accurate parameter, because of better sensitivity and specificity. However, while polyp size ${\geq}19.5mm$ seems to have a great accuracy for predicting premalignancy and malignancy, histologic evaluation is still necessary to exclude premalignant and malignant polyps.

• Development and Reproduction
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• v.15 no.4
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• pp.291-299
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• 2011

The membranous adhesions could induce implantation failure despite transplantation of high quality of embryo. Clinically, of the patients who have membranous filmy adhesions, endometrial polyps have been found in not infrequently. Thus this study was tried to evaluate the features of endometrial polyps and the effect of endometrial polyps on formation and extents of membranous adhesions in uterine cavity of infertile patients under hysteroscopy. A retrospective study was conducted on 34 infertile patients who were diagnosed as endometrial polyps with membranous adhesions during hysteroscopy from July 2008 to July 2011. Number, size, location and morophologic type of endometrial polyps were investigated. If needed, methylene blue solution was instillated to endometrial cavity to identify membranous adhesions. Then, associations between membranous adhesions with features of endometrial polyps were evaluated. Mean size of endometrial polyp was $1.6{\pm}0.6$ cm, the bigger of endometrial polyps was, the larger of extents of membranous adhesions. (p<0.05). Endometrial polyps were locate evenly in endometrial cavity as follows: anterior uterine wall, 39.1%; posterior uterine wall, 34.8%; lateral uterine wall, 26.1%; upper: 29.4%, middle: 32.4%, lower segment, 35.3%. Mean number of endometrial polyps was $2.26{\pm}1.3$. The pedunculated type was 37.7% and sessile type was 32.4%. There was no statistically significant association of location, number and morphologic type of endometrial polyps with membranous adhesions. In conclusion, hysteroscopy before in vitro fertilization on infertile patients was worthy because of removing of endometrial polyps and membranous adhesions.

• 대한생식의학회:학술대회논문집
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• 2000.02a
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• pp.45-51
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• 2000

• Clinical and Experimental Reproductive Medicine
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• v.32 no.3
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• pp.223-230
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• 2005

Objective: This study was performed to evaluate the accuracy of hysterosalpingography (HSG) for evaluating female infertility patients by comparison with hysteroscopic and laparoscopic examination. Methods and Material: Total 219 infertile patients were retrospectively analyzed between January 1, 2002 and December 31, 2003. Ninety seven patients (44.3%) were primary infertility, 122 patients (55.7%) were secondary infertility. We performed hysteroscopic and laparoscopic examination on next cycle when HSG revealed any abnormal finding, and 3~6 cycles later if HSG was normal. Results: The accuracy of HSG was 65.2% compared with hysteroscopic examination (sensitivity 88.4%, specificity 46.4%, false positive rate 53.6%, false negative rate 11.6%). The most common abnormal finding of hysteroscopy was uterine synechia (67.4%) followed by endometrial polyp, uterine anomaly (e.g. uterine septum), endometrial hyperplasia. Compared with laparoscopic examination, the accuracy of HSG was 76.9% (sensitivity 98.9%, specificity 70.6%, +LR 3.36, -LR 0.02). The positive predictive value of normal patent tube was excellent (99.6%) but that of proximal tubal blockage was only 46.7%. The unilateral tubal obstruction of HSG was poor accuracy (+LR 3.85 -LR 0.68) and 70% of those was patent by laparoscopic examination. Laparoscopic examination also revealed that 53% of patients had peritubal adhesion and 37% of patients has additional pelvic findings, especially endometriosis. Among the patients had normal HSG, 53.5% patients with normal ultrasonography was diagnosed endometriosis (25.6% of them had endometriosis stage I-II). Conclusion: Normal HSG shows a high negative predictive value. Nevertheless, the incidence of associated pelvic disease in the normal HSG group is high enough to warrant diagnostic laparoscopy if nonsurgical treatment is unsuccessful. Because HSG has poor accuracy in predicting distal tubal blockage and peritubal adhesion, and poor positive predictive value of proximal tubal blockage, laparoscopic examination could be considered in abnormal HSG group.

• Journal of Medicine and Life Science
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• v.21 no.2
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• pp.21-30
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• 2024

The purpose of this prospective study was to investigate whether office hysteroscopy (OH) can be used to assess the mechanisms of action of progestogen-only contraceptives (POCs), diagnose possible local causes of abnormal uterine bleeding (AUB), and support the treatment plan of symptomatic patients using POCs compared with those who do not use hormones. The study included 140 women who were divided into two groups. Group A consisted of 70 women who used POCs, whereas group B consisted of 70 women who did not use hormones. They were successively examined using transvaginal ultrasonography (TVS), OH, and endometrial sampling. The TVS results were consistent with those of OH and histopathology. The changes in endometrial thickness and vasculature, as well as fallopian tube (FT) functions, were significantly more pronounced in POC users than in non-POC users. There was a significant reduction in the peristalsis of the proximal part of the FT, as well as a reduction in the bubble flow test in group A compared with group B. In addition, the combination of peristalsis and the bubble flow test (Darwishscope test) was significantly lower in group A. It was concluded that using OH as a simple diagnostic tool in women with POCs would contribute to a better understanding of the mechanisms of endometrial and FT effects and explain some local endometrial causes of AUB. This ensures that the combination of TVS and OH would limit routine endometrial sampling in POCs users.

• Clinical and Experimental Reproductive Medicine
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• v.48 no.1
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• pp.91-94
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• 2021

A 28-year-old woman presented with a 1-year history of severe progressive dysmenorrhea following suction evacuation and tubal ligation. Sonography showed a bicornuate uterus with hematometra in the left horn. Hysteroscopy ruled out a diagnosis of a congenital Müllerian anomaly, as both ostia appeared normal. Under laparoscopy, a mass was seen on the left fundal region near the insertion of the round ligament, and needle aspiration of a chocolate-colored fluid confirmed the diagnosis of an adenomyotic cyst. The cyst was excised. The patient recovered well and has been symptom-free since surgery. Adenomyotic cyst is a rare entity in young women and must be differentiated from obstructive Müllerian anomaly. Laparoscopy is the preferred minimally invasive modality for managing this rare disorder.

• Clinical and Experimental Reproductive Medicine
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• v.43 no.4
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• pp.185-192
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• 2016

Chronic endometritis (CE) is a condition involving the breakdown of the peaceful co-existence between microorganisms and the host immune system in the endometrium. A majority of CE cases produce no noticeable signs or mild symptoms, and the prevalence rate of CE has been found to be approximately 10%. Gynecologists and pathologists often do not focus much clinical attention on CE due to the time-consuming microscopic examinations necessary to diagnose CE, its mild clinical manifestations, and the benign nature of the disease. However, the relationship between CE and infertility-related conditions such as repeated implantation failure and recurrent miscarriage has recently emerged as an area of inquiry. In this study, we reviewed the literature on the pathophysiology of CE and how it may be associated with infertility, as well as the literature regarding the diagnosis and treatment of CE. In addition, we discuss the value of hysteroscopic procedures in the diagnosis and treatment of CE.

• Clinical and Experimental Reproductive Medicine
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• v.18 no.1
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• pp.113-120
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• 1991

Etiologic classification was performed in 155 patients with recurrent spontaneous abortion history. The incidence was 9.3% among 1658 pregnant women at Hanyang university hospital during the same period. In etiologic classification, 37 cases of on-going patients for diagnostic evaluation were excluded. Of the remained 118 patients, the patients with unknown etiology were 32 cases (27.1%), and 86 cases were classified into each etiologies using appropriate diagnostic modalities. Anatomic causes were the largest etiology, which revealed 46.6% (55 among 118 patients). The next etiology was immunologic cause, which revealed 24.6% (29 patients). Of the 86 patients who have at least one cause, 40.7% (35 among 86) have two or more etiologies. Furthermore, six cases (7%) have 3 combined etiologies. The uterine synechia and/or incompetent internal os of the cervix, namaly anatomic causes, revealed highest combination ratio than other etilogies. The popular abortion technique in Korea, D&C, seems to be main factors for these anatmic causes. The combined causes rather than single cause of recurrent spontaneous abortion were unique situation in Korea especially with anatomic etiologies. From this point of view, we think anatomic etiologies should be rule out first in the evaluation of the patients. For this purpose, we believe hysteroscopy would be helpful as a diagnostic work-up and treatment modality in the management of recurrent spontaneous abortion patients in Korea.