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Nguyen E, Strug M, Gardner A, Burney R, Campbell S, Aghajanova L. Initial fertility evaluation with saline sonography vs. hysterosalpingography: it is debate-tubal. Fertil Steril 2024; 121:922-930. [PMID: 38703168 DOI: 10.1016/j.fertnstert.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/02/2024] [Indexed: 05/06/2024]
Affiliation(s)
- Edward Nguyen
- Division Reproductive Endocrinology and Infertility, Stanford University School of Medicine, Sunnyvale, California
| | - Michael Strug
- Division Reproductive Endocrinology and Infertility, Stanford University School of Medicine, Sunnyvale, California
| | - Austin Gardner
- Division Reproductive Endocrinology and Infertility, University of Alabama at Birmingham, Birmingham, Alabama
| | - Richard Burney
- Division Reproductive Endocrinology and Infertility, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sukhkamal Campbell
- Division Reproductive Endocrinology and Infertility, University of Alabama at Birmingham, Birmingham, Alabama
| | - Lusine Aghajanova
- Division Reproductive Endocrinology and Infertility, Stanford University School of Medicine, Sunnyvale, California
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Alonso L, Carugno J, Nappi L. Diagnostic accuracy of hysteroscopy, ultrasound and magnetic resonance imaging in detecting congenital uterine anomalies. Minerva Obstet Gynecol 2020; 74:12-23. [PMID: 33306285 DOI: 10.23736/s2724-606x.20.04723-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Congenital uterine malformations occur as a result of a defective uterine development. The formation of the uterus is a dynamic process that culminates after completing four phases (differentiation, fusion, migration and canalization). Because is an evolutionary process, the resulting uterine malformation is different depending on the uterine formation phase in which the failure occurs. To establish a correct diagnosis of uterine malformations, it is necessary to evaluate both the shape of the uterine cavity and the external contour of the uterus. In this review we will describe the imaging modalities used in current clinical practice for the evaluation of the patient with suspected congenital uterine anomalies. The current role of each modality is described.
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Affiliation(s)
- Luis Alonso
- Unit of Hysteroscopy, Gutenberg Center, Malaga, Spain -
| | - Jose Carugno
- Division of Minimally Invasive Gynecology, Department of Obstetrics, Gynecology and Reproductive Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Luigi Nappi
- Unit of Obstetrics and Gynaecology, Department of Surgical Sciences, University of Foggia, Foggia, Italy
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Poliakova Y, Lutsenko N. Diagnostic Accuracy of Transvaginal Sonography in the Detection of Endometrial Polyps. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2020. [DOI: 10.1177/8756479319879374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Transvaginal sonography (TVS) is considered a simple and generally accepted method for detecting uterine anomalies. With TVS, the uterus can be clearly visualized, but so far, the diagnostic accuracy of TVS varies across different studies. This retrospective study was devised to evaluate the accuracy of a sonographic diagnosis of endometrial polyps in a Ukrainian hospital. Methods: This was a single-center retrospective study of woman who underwent TVS and had hysteroscopy or dilation and curettage for endometrial pathology. A cohort of 156 women were included in this yearlong study. A comparative analysis was based on the preoperative diagnosis, according to TVS, compared with the postoperative histopathology results. Results: The overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of TVS in diagnosing endometrial polyps were 69%, 51%, 73%, 46%, and 63%, respectively. Conclusion: This retrospective study provided data on the lack of accuracy for a sonographic diagnosis of endometrial polyps. This was based on 26% of women whose diagnosis was not confirmed by histology. A false-negative result occurred for 54% of women who had polyps that were not detected at the preoperative stage. These data raise the question of the feasibility of further invasive procedures based on a single TVS study.
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Affiliation(s)
| | - Nataliia Lutsenko
- Department of Obstetrics and Gynecology, SI Zaporizhzhia Medical Academy of Post-Graduate Education of Ministry of Health of Ukraine, Zaporizhzhia, Ukraine
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Namazov A, Gemer O, Bart O, Cohen O, Vaisbuch E, Kapustian V, Ben-Arie A. Effect of Menopausal Status on the Diagnosis of Endometrial Polyp. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:926-929. [DOI: 10.1016/j.jogc.2018.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/14/2018] [Accepted: 08/14/2018] [Indexed: 10/27/2022]
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Kamath MS, Bosteels J, D'Hooghe TM, Seshadri S, Weyers S, Mol BWJ, Broekmans FJ, Sunkara SK. Screening hysteroscopy in subfertile women and women undergoing assisted reproduction. Cochrane Database Syst Rev 2019; 4:CD012856. [PMID: 30991443 PMCID: PMC6472583 DOI: 10.1002/14651858.cd012856.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Screening hysteroscopy in infertile women with unexplained infertility, or prior to intrauterine insemination (IUI) or in vitro fertilisation (IVF) may reveal intrauterine pathology that may not be detected by routine transvaginal ultrasound. Hysteroscopy, whether purely diagnostic or operative may improve reproductive outcomes. OBJECTIVES To assess the effectiveness and safety of screening hysteroscopy in subfertile women undergoing evaluation for infertility, and subfertile women undergoing IUI or IVF. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility Group Specialised Register, CENTRAL CRSO, MEDLINE, Embase, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform (September 2018). We searched reference lists of relevant articles and handsearched relevant conference proceedings. SELECTION CRITERIA Randomised controlled trials comparing screening hysteroscopy versus no intervention in subfertile women wishing to conceive spontaneously, or before undergoing IUI or IVF. DATA COLLECTION AND ANALYSIS We independently screened studies, extracted data, and assessed the risk of bias. The primary outcomes were live birth rate and complications following hysteroscopy. We analysed data using risk ratio (RR) and a fixed-effect model. We assessed the quality of the evidence by using GRADE criteria. MAIN RESULTS We retrieved 11 studies. We included one trial that evaluated screening hysteroscopy versus no hysteroscopy, in women with unexplained subfertility, who were trying to conceive spontaneously. We are uncertain whether ongoing pregnancy rate improves following a screening hysteroscopy in women with at least two years of unexplained subfertility (RR 4.30, 95% CI 2.29 to 8.07; 1 RCT; participants = 200; very low-quality evidence). For a typical clinic with a 10% ongoing pregnancy rate without hysteroscopy, performing a screening hysteroscopy would be expected to result in ongoing pregnancy rates between 23% and 81%. The included study reported no adverse events in either treatment arm. We are uncertain whether clinical pregnancy rate is improved (RR 3.80, 95% CI 2.31 to 6.24; 1 RCT; participants = 200; very low-quality evidence), or miscarriage rate increases (RR 2.80, 95% CI 1.05 to 7.48; 1 RCT; participants = 200; very low-quality evidence), following screening hysteroscopy in women with at least two years of unexplained subfertility.We included ten trials that included 1836 women who had a screening hysteroscopy and 1914 women who had no hysteroscopy prior to IVF. Main limitations in the quality of evidence were inadequate reporting of study methods and higher statistical heterogeneity. Eight of the ten trials had unclear risk of bias for allocation concealment.Performing a screening hysteroscopy before IVF may increase live birth rate (RR 1.26, 95% CI 1.11 to 1.43; 6 RCTs; participants = 2745; I² = 69 %; low-quality evidence). For a typical clinic with a 22% live birth rate, performing a screening hysteroscopy would be expected to result in live birth rates between 25% and 32%. However, sensitivity analysis done by pooling results from trials at low risk of bias showed no increase in live birth rate following a screening hysteroscopy (RR 0.99, 95% CI 0.82 to 1.18; 2 RCTs; participants = 1452; I² = 0%).Only four trials reported complications following hysteroscopy; of these, three trials recorded no events in either group. We are uncertain whether a screening hysteroscopy is associated with higher adverse events (Peto odds ratio 7.47, 95% CI 0.15 to 376.42; 4 RCTs; participants = 1872; I² = not applicable; very low-quality evidence).Performing a screening hysteroscopy before IVF may increase clinical pregnancy rate (RR 1.32, 95% CI 1.20 to 1.45; 10 RCTs; participants = 3750; I² = 49%; low-quality evidence). For a typical clinic with a 28% clinical pregnancy rate, performing a screening hysteroscopy would be expected to result in clinical pregnancy rates between 33% and 40%.There may be little or no difference in miscarriage rate following screening hysteroscopy (RR 1.01, 95% CI 0.67 to 1.50; 3 RCTs; participants = 1669; I² = 0%; low-quality evidence).We found no trials that compared a screening hysteroscopy versus no hysteroscopy before IUI. AUTHORS' CONCLUSIONS At present, there is no high-quality evidence to support the routine use of hysteroscopy as a screening tool in the general population of subfertile women with a normal ultrasound or hysterosalpingogram in the basic fertility work-up for improving reproductive success rates.In women undergoing IVF, low-quality evidence, including all of the studies reporting these outcomes, suggests that performing a screening hysteroscopy before IVF may increase live birth and clinical pregnancy rates. However, pooled results from the only two trials with a low risk of bias did not show a benefit of screening hysteroscopy before IVF.Since the studies showing an effect are those with unclear allocation concealment, we are uncertain whether a routine screening hysteroscopy increases live birth and clinical pregnancy, be it for all women, or those with two or more failed IVF attempts. There is insufficient data to draw conclusions about the safety of screening hysteroscopy.
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Affiliation(s)
- Mohan S Kamath
- Christian Medical CollegeDepartment of Reproductive MedicineIda Scudder RoadVelloreTamil NaduIndia632004
| | - Jan Bosteels
- Cochrane BelgiumAcademic Centre for General PracticeKapucijnenvoer 33blok J bus 7001LeuvenBelgium3000
| | - Thomas M D'Hooghe
- University Hospital GasthuisbergLeuven University Fertility CentreHerestraat 49LeuvenBelgium3000
| | - Srividya Seshadri
- The Centre for Reproductive & Genetic Health256 Gray’s Inn RoadLondonUKWC1X 8LD
| | - Steven Weyers
- University Hospital GhentObstetrics and GynaecologyDe Pintelaan 185GhentBelgium
| | - Ben Willem J Mol
- Monash UniversityDepartment of Obstetrics and Gynaecology246 Clayton RoadClaytonVictoriaAustralia3168
| | - Frank J Broekmans
- University Medical CenterDepartment of Reproductive Medicine and GynecologyHeidelberglaan 100UtrechtNetherlands3584 CX
| | - Sesh Kamal Sunkara
- King's College LondonDivision of Women's Health, Faculty of Life Sciences & MedicineStrandLondonUKWC2R 2LS
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Şık BA, Özcan A, Kumbasar S, Bozkurt M, Bilecan S. Intrauterine interventions with the aid of ultrasonography. ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2018. [DOI: 10.25000/acem.376841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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7
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Lopes VM, Barguil JP, Lacerda TS, Souza ALM, Rocha Filho AMD, Roller MF, Barbosa EA, Tierno NZ, Lopes JRC. An overview of the results of hysterosonography prior to in vitro fertilization. JBRA Assist Reprod 2017; 21:302-305. [PMID: 28960053 PMCID: PMC5714596 DOI: 10.5935/1518-0557.20170051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective This study aimed to analyze the results of hysterosonography performed prior
to in vitro fertilization (IVF) and to correlate anomalous
findings with hysteroscopy. Methods Findings from 197 hysterosonograms of patients examined in an assisted
reproduction clinic between January 2012 and August 2014 were included.
Enrollment criteria: patients in preparation for IVF not recently submitted
to uterine examination through hysterosalpingography or hysteroscopy
referred to hysterosonography. Uterine cavity evaluation was considered
anomalous when one or more of the following were found: polyps, submucous
myomas, uterine synechiae, Müllerian duct anomalies. Individuals with
cavity abnormalities that might interfere with IVF results were referred to
hysteroscopy. Results Normal test results were seen in 170/197 of the cases (86.3%). Eighteen of
the 197 cases (9.1%) were suspected for polyps, two (1%) for submucous
myoma, six (3.5%) for synechiae, and one (0.5%) for Müllerian duct
anomalies. Sixteen of the patients diagnosed with abnormalities underwent
hysteroscopy to confirm or treat the suspected pathology. In only two cases
there was no agreement between tests: one patient suspected for synechiae
and another for polyps were not confirmed; another individual suspected for
polyps was found to have focal endometrial thickening in hysteroscopy. The
positive predictive value (PPV) in our study was 93.7%. Conclusion In most cases, the diagnoses obtained by hysterosonography showed normal
uterine cavities. The most common anomalous findings were polyps, followed
by synechiae, submucous myoma, and Müllerian duct anomalies.
Hysterosonography is a good option for evaluating the uterus and offers a
high positive predictive value, while hysteroscopy stands as the gold
standard.
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Diagnostic accuracy of 3D-transvaginal ultrasound in detecting uterine cavity abnormalities in infertile patients as compared with hysteroscopy. Eur J Obstet Gynecol Reprod Biol 2016; 200:24-8. [DOI: 10.1016/j.ejogrb.2016.01.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 01/10/2016] [Accepted: 01/29/2016] [Indexed: 12/29/2022]
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Reda A, Hamid ASA, Mostafa R, Refaei E. Comparison between findings of saline infusion sonohysterography and office hysteroscopy in patients with recurrent implantation failure. J Hum Reprod Sci 2016; 9:236-240. [PMID: 28216911 PMCID: PMC5296827 DOI: 10.4103/0974-1208.197661] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM: This study aims to determine the accuracy of saline infusion sonohysterography (SIS) in the diagnosis of intrauterine pathologies in women with recurrent implantation failure (RIF). SETTINGS AND DESIGN: This is a prospective cross-over study which was carried out during the period between December 2013 and July 2014. MATERIALS AND METHODS: The study involved sixty subfertile women with a history of RIF. All cases underwent a transvaginal ultrasonography, SIS and then an office hysteroscopy (1 day after SIS) during early follicular phase. SIS was carried out by same sonographer, and then hysteroscopy was carried out by same gynecologist who was kept blind to findings at SIS. STATISTICAL ANALYSIS: Was done using IBM© SPSS© Statistics version 22. The sensitivity of SIS was calculated as it equals: True positive by SIS/all positive (true cases by hysteroscopy) and specificity was calculated as it equals: True negative by SIS/all negatives (normal by hysteroscopy). RESULTS: Overall uterine abnormalities were significantly less likely to be identified with SIS compared to hysteroscopy (P = 0.002), but analysis of each finding separately demonstrated a comparable difference between SIS and hysteroscopy (P > 0.05). We found that the sensitivity, specificity, positive predictive value, and negative predictive value of SIS to detect intrauterine pathology is 41.2%, 100%, 100%, and 81.1%, respectively. CONCLUSION: Our findings suggest a good role of SIS in the workup for RIF saving more invasive procedure for selected cases.
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Affiliation(s)
- Ahmed Reda
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed Sherif Abdel Hamid
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Rowaa Mostafa
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Eman Refaei
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Phillips CH, Benson CB, Ginsburg ES, Frates MC. Comparison of uterine and tubal pathology identified by transvaginal sonography, hysterosalpingography, and hysteroscopy in female patients with infertility. FERTILITY RESEARCH AND PRACTICE 2015; 1:20. [PMID: 28620525 PMCID: PMC5424419 DOI: 10.1186/s40738-015-0012-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 12/15/2015] [Indexed: 11/10/2022]
Abstract
Background The causes of female infertility are multifactorial and necessitate comprehensive evaluation including physical examination, hormonal testing, and imaging. Given the associated psychological and financial stress that imaging can cause, infertility patients benefit from a structured and streamlined evaluation. The goal of such a work up is to evaluate the uterus, endometrium, and fallopian tubes for anomalies or abnormalities potentially preventing normal conception. To date, the standard method for assessing these structures typically involves some combination of transvaginal sonography (TVS), hysterosalpingography (HSG), and hysteroscopy (HSC). The goal of this review is to compare the diagnostic accuracy of TVS, HSG, and HSC for diagnosing abnormalities in infertility patients to determine if all studies are necessary for pre-treatment evaluation. Results We identified infertility patients prior to initiation of assisted reproductive technology who had baseline TVS, HSG, and HSC within 180 days of each other. From medical record review, we compared frequencies of each finding between modalities. Of the 1274 patients who received a baseline TVS over 2 years, 327 had TVS and HSG within 180 days and 55 patients had TVS, HSG and HSC. Of the 327, TVS detected fibroids more often than HSG (74 vs. 5, p < .0001), and adenomyosis more often than HSG (7 vs. 2, p = .02). HSG detected tubal obstruction more often than TVS (56 vs. 8, p = .002). Four (1.2 %) patients had endometrial polyps on both HSG and TVS. In the 55 patients with HSG, TVS, and HSC, HSC identified endometrial polyps more often than TVS (10 vs. 1, p = .0001) and HSG (10 vs. 2, p = .0007). TVS detected more fibroids than HSC (17 vs. 5, p < .0001). Tubal obstruction was identified more often by HSG than HSC (19 vs. 5, p < .0001). Conclusions TVS is superior for evaluation of myometrial pathology. HSG is superior for evaluation of tubal pathologies. Endometrial pathologies are best identified with HSC.
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Affiliation(s)
- Catherine H Phillips
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Carol B Benson
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Elizabeth S Ginsburg
- Department of Infertility and Reproductive Surgery, Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Mary C Frates
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
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11
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Cogendez E, Eken MK, Bakal N, Gun I, Kaygusuz EI, Karateke A. The role of transvaginal power Doppler ultrasound in the differential diagnosis of benign intrauterine focal lesions. J Med Ultrason (2001) 2015; 42:533-40. [PMID: 26576978 DOI: 10.1007/s10396-015-0628-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/25/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this prospective study was to assess the role of power Doppler imaging in the differential diagnosis of benign intrauterine focal lesions such as endometrial polyps and submucous myomas using the characteristics of power Doppler flow mapping. METHODS A total of 480 premenopausal patients with abnormal uterine bleeding were evaluated by transvaginal ultrasonography (TVS) searching for intrauterine pathology. Sixty-four patients with a suspicious focal endometrial lesion received saline infusion sonography (SIS) after TVS. Fifty-eight patients with focal endometrial lesions underwent power Doppler ultrasound (PDUS). Three different vascular flow patterns were defined: Single vessel pattern, multiple vessel pattern, and circular flow pattern. Finally, hysteroscopic resection was performed in all cases, and Doppler flow characteristics were then compared with the final histopathological findings. RESULTS Histopathological results were as follows: endometrial polyp: 40 (69 %), submucous myoma: 18 (31 %). Of the cases with endometrial polyps, 80 % demonstrated a single vessel pattern, 7.5 % a multiple vessel pattern, and 0 % a circular pattern. Vascularization was not observed in 12.5 % of patients with polyps. Of the cases with submucousal myomas, 72.2 % demonstrated a circular flow pattern, 27.8 % a multiple vessel pattern, and none of them showed a single vessel pattern. The sensitivity, specificity, and positive and negative predictive values of the single vessel pattern in diagnosing endometrial polyps were 80, 100, 100, and 69.2 %, respectively; and for the circular pattern in diagnosing submucous myoma, these were 72.2, 100, 100, and 88.9 %, respectively. CONCLUSION Power Doppler blood flow mapping is a useful, practical, and noninvasive diagnostic method for the differential diagnosis of benign intrauterine focal lesions. Especially in cases of recurrent abnormal uterine bleeding, recurrent abortion, and infertility, PDUS can be preferred as a first-line diagnostic method.
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Affiliation(s)
- Ebru Cogendez
- Gynecology Department, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey.
| | - Meryem Kurek Eken
- Gynecology Department, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Nuray Bakal
- Radiology Department, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Ismet Gun
- Gynecology Department, GATA Haydarpasa Training Hospital, Istanbul, Turkey
| | - Ecmel Isik Kaygusuz
- Pathology Department, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Ates Karateke
- Gynecology Department, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
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12
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Grimbizis GF, Di Spiezio Sardo A, Saravelos SH, Gordts S, Exacoustos C, Van Schoubroeck D, Bermejo C, Amso NN, Nargund G, Timmerman D, Athanasiadis A, Brucker S, De Angelis C, Gergolet M, Li TC, Tanos V, Tarlatzis B, Farquharson R, Gianaroli L, Campo R. The Thessaloniki ESHRE/ESGE consensus on diagnosis of female genital anomalies. Hum Reprod 2015; 31:2-7. [PMID: 26537921 DOI: 10.1093/humrep/dev264] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 09/14/2015] [Indexed: 11/15/2022] Open
Abstract
STUDY QUESTION What is the recommended diagnostic work-up of female genital anomalies according to the European Society of Human Reproduction and Embryology (ESHRE)/European Society for Gynaecological Endoscopy (ESGE) system? SUMMARY ANSWER The ESHRE/ESGE consensus for the diagnosis of female genital anomalies is presented. WHAT IS KNOWN ALREADY Accurate diagnosis of congenital anomalies still remains a clinical challenge because of the drawbacks of the previous classification systems and the non-systematic use of diagnostic methods with varying accuracy, some of them quite inaccurate. Currently, a wide range of non-invasive diagnostic procedures are available enriching the opportunity to accurately detect the anatomical status of the female genital tract, as well as a new objective and comprehensive classification system with well-described classes and sub-classes. STUDY DESIGN, SIZE, DURATION The ESHRE/ESGE CONgenital UTerine Anomalies (CONUTA) Working Group established an initiative with the goal of developing a consensus for the diagnosis of female genital anomalies. The CONUTA working group and imaging experts in the field have been appointed to run the project. PARTICIPANTS/MATERIALS, SETTING, METHODS The consensus is developed based on: (i) evaluation of the currently available diagnostic methods and, more specifically, of their characteristics with the use of the experts panel consensus method and of their diagnostic accuracy by performing a systematic review of evidence and (ii) consensus for the definition of where and how to measure uterine wall thickness and the recommendations for the diagnostic work-up of female genital anomalies, based on the results of the previous evaluation procedure, with the use of the experts panel consensus method. MAIN RESULTS AND THE ROLE OF CHANCE Uterine wall thickness is defined as the distance between the interostial line and external uterine profile at the midcoronal plane of the uterus; alternatively, if a coronal plane is not available, the mean anterior and posterior uterine wall thickness at the longitudinal plane could be used. Gynecological examination and two-dimensional ultrasound (2D US) are recommended for the evaluation of asymptomatic women. Three-dimensional (3D) US is recommended for the diagnosis of female genital anomalies in 'symptomatic' patients belonging to high risk groups for the presence of a female genital anomaly and in any asymptomatic woman suspected to have an anomaly from routine evaluation. Magnetic resonance imaging (MRI) and endoscopic evaluation are recommended for the subgroup of patients with suspected complex anomalies or in diagnostic dilemmas. Adolescents with symptoms suggestive for the presence of a female genital anomaly should be thoroughly evaluated with 2D US, 3D US, MRI and endoscopically. LIMITATIONS, REASONS FOR CAUTION The various diagnostic methods should always be used in the proper way and evaluated by experts to avoid mis-, over- and underdiagnosis. WIDER IMPLICATIONS OF THE FINDINGS The role of a combined US examination and outpatient hysteroscopy should be prospectively evaluated. It is a challenge for further research, based on diagnosis, to objectively evaluate the clinical consequences related to various degrees of uterine deformity. STUDY FUNDING/COMPETING INTERESTS None.
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Affiliation(s)
- Grigoris F Grimbizis
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Attilio Di Spiezio Sardo
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Sotirios H Saravelos
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Stephan Gordts
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Caterina Exacoustos
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Dominique Van Schoubroeck
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Carmina Bermejo
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Nazar N Amso
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Geeta Nargund
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Dirk Timmerman
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Apostolos Athanasiadis
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Sara Brucker
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Carlo De Angelis
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Marco Gergolet
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Tin Chiu Li
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Vasilios Tanos
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Basil Tarlatzis
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Roy Farquharson
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Luca Gianaroli
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Rudi Campo
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
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The Thessaloniki ESHRE/ESGE consensus on diagnosis of female genital anomalies. ACTA ACUST UNITED AC 2015; 13:1-16. [PMID: 26918000 PMCID: PMC4753246 DOI: 10.1007/s10397-015-0909-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 07/20/2015] [Indexed: 11/27/2022]
Abstract
What is the recommended diagnostic work-up of female genital anomalies according to the European Society of Human Reproduction and Embryology (ESHRE)/European Society for Gynaecological Endoscopy (ESGE) system? The ESHRE/ESGE consensus for the diagnosis of female genital anomalies is presented. Accurate diagnosis of congenital anomalies still remains a clinical challenge due to the drawbacks of the previous classification systems and the non-systematic use of diagnostic methods with varying accuracy, with some of them quite inaccurate. Currently, a wide range of non-invasive diagnostic procedures are available, enriching the opportunity to accurately detect the anatomical status of the female genital tract, as well as a new objective and comprehensive classification system with well-described classes and sub-classes. The ESHRE/ESGE Congenital Uterine Anomalies (CONUTA) Working Group established an initiative with the goal of developing a consensus for the diagnosis of female genital anomalies. The CONUTA working group and imaging experts in the field have been appointed to run the project. The consensus is developed based on (1) evaluation of the currently available diagnostic methods and, more specifically, of their characteristics with the use of the experts panel consensus method and of their diagnostic accuracy performing a systematic review of evidence and (2) consensus for (a) the definition of where and how to measure uterine wall thickness and (b) the recommendations for the diagnostic work-up of female genital anomalies, based on the results of the previous evaluation procedure, with the use of the experts panel consensus method. Uterine wall thickness is defined as the distance between interostial line and external uterine profile at the midcoronal plane of the uterus; alternatively, if a coronal plane is not available, the mean anterior and posterior uterine wall thickness at the longitudinal plane could be used. Gynaecological examination and two-dimensional ultrasound (2D US) are recommended for the evaluation of asymptomatic women. Three-dimensional ultrasound (3D US) is recommended for the diagnosis of female genital anomalies in “symptomatic” patients belonging to high-risk groups for the presence of a female genital anomaly and in any asymptomatic woman suspected to have an anomaly from routine avaluation. Magnetic resonance imaging (MRI) and endoscopic evaluation are recommended for the sub-group of patients with suspected complex anomalies or in diagnostic dilemmas. Adolescents with symptoms suggestive for the presence of a female genital anomaly should be thoroughly evaluated with 2D US, 3D US, MRI and endoscopy. The various diagnostic methods should be used in a proper way and evaluated by experts to avoid mis-, over- and underdiagnosis. The role of a combined ultrasound examination and outpatient hysteroscopy should be prospectively evaluated. It is a challenge for further research, based on diagnosis, to objectively evaluate the clinical consequences related to various degrees of uterine deformity.
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Cavkaytar S, Kokanali MK, Ceran U, Topcu HO, Sirvan L, Doganay M. Roles of sonography and hysteroscopy in the detection of premalignant and malignant polyps in women presenting with postmenopausal bleeding and thickened endometrium. Asian Pac J Cancer Prev 2015; 15:5355-8. [PMID: 25041001 DOI: 10.7314/apjcp.2014.15.13.5355] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
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 premalignant 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 ≥ 19.5mm seems to have a great accuracy for predicting premalignancy and malignancy, histologic evaluation is still necessary to exclude premalignant and malignant polyps.
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Affiliation(s)
- Sabri Cavkaytar
- Department of Gynecology, Dr Zekai Tahir Burak Woman's Health Education and Research Hospital, Ankara, Turkey E-mail :
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Seshadri S, El-Toukhy T, Douiri A, Jayaprakasan K, Khalaf Y. Diagnostic accuracy of saline infusion sonography in the evaluation of uterine cavity abnormalities prior to assisted reproductive techniques: a systematic review and meta-analyses. Hum Reprod Update 2014; 21:262-74. [DOI: 10.1093/humupd/dmu057] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Vitner D, Filmer S, Goldstein I, Khatib N, Weiner Z. A comparison between ultrasonography and hysteroscopy in the diagnosis of uterine pathology. Eur J Obstet Gynecol Reprod Biol 2013; 171:143-5. [DOI: 10.1016/j.ejogrb.2013.08.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 07/09/2013] [Accepted: 08/12/2013] [Indexed: 10/26/2022]
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Surrey ES. Should Diagnostic Hysteroscopy be Performed Before In Vitro Fertilization-Embryo Transfer? J Minim Invasive Gynecol 2012; 19:643-6. [DOI: 10.1016/j.jmig.2012.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 04/03/2012] [Accepted: 04/05/2012] [Indexed: 01/23/2023]
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Karayalçın R, Özyer Ş, Özcan S, Uzunlar Ö, Gürlek B, Moraloğlu Ö, Batıoğlu S. Office hysteroscopy improves pregnancy rates following IVF. Reprod Biomed Online 2012; 25:261-6. [DOI: 10.1016/j.rbmo.2012.05.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 05/25/2012] [Accepted: 05/29/2012] [Indexed: 10/28/2022]
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Acholonu UC, Silberzweig J, Stein DE, Keltz M. Hysterosalpingography versus sonohysterography for intrauterine abnormalities. JSLS 2012; 15:471-4. [PMID: 22643500 PMCID: PMC3340954 DOI: 10.4293/108680811x13176785203923] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Sonohysterography was found to be more sensitive, specific, and accurate in the evaluation of specific intrauterine defects than hysterosalpingography. Objective: The hysterosalpingogram is commonly used to evaluate the uterine cavity and the fallopian tubes in the workup of infertile couples. The sonohysterogram is gaining popularity as part of this evaluation. This study compares hysterosalpingography to sonohysterography for the detection of polyps, cavitary fibroids, adhesions, and septae in infertile patients. Methods: We conducted a retrospective chart review of 149 infertility patients seen at a University Hospital Center, divisions of Reproductive Endocrinology and Interventional Radiology. Patients underwent hysterosalpingography and sonohysterography as part of their infertility evaluation. The reports were reviewed and findings like polyps, fibroids, adhesions, and septae were compared to the findings obtained at the time of hysteroscopy. Sensitivity, specificity, and accuracy of radiologic tests were the main outcome measures. Results: The sensitivity of hysterosalpingography and sonohysterography was 58.2% and 81.8%, respectively. The specificity for hysterosalpingography and sonohysterography was 25.6% and 93.8%. The differences in sensitivity and specificity were both statistically significant. Hysterosalpingography had a general accuracy of 50.3%, while sonohysterography had a significantly higher accuracy of 75.5%. Conclusion: Although hysterosalpingography is the standard screening test for the diagnosis of tubal infertility and can provide useful information about the uterine cavity, sonohysterography is more sensitive, specific, and accurate in the evaluation of the uterine cavity.
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AAGL Practice Report: Practice Guidelines for the Diagnosis and Management of Endometrial Polyps. J Minim Invasive Gynecol 2012; 19:3-10. [DOI: 10.1016/j.jmig.2011.09.003] [Citation(s) in RCA: 160] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 09/03/2011] [Indexed: 01/02/2023]
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Salim S, Won H, Nesbitt-Hawes E, Campbell N, Abbott J. Diagnosis and Management of Endometrial Polyps: A Critical Review of the Literature. J Minim Invasive Gynecol 2011; 18:569-81. [DOI: 10.1016/j.jmig.2011.05.018] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 05/18/2011] [Accepted: 05/26/2011] [Indexed: 01/02/2023]
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Torre A, Pouly JL, Wainer B. [Anatomic evaluation of the female of the infertile couple]. ACTA ACUST UNITED AC 2011; 39:S34-44. [PMID: 21185484 DOI: 10.1016/s0368-2315(10)70029-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
One third of infertility cases are due to anatomical abnormalities of the female reproductive tract: endometrial polyps (33%), bilateral tubal blockage (12%), hydrosalpinx (7%), sub-mucosal fibroids (3%) and pelvic endometriosis. These may need surgical correction which could restore fertility. This review aim to determine which examinations should be performed first. Hysterosalpingography shows sensitivity of only 65% but it increases the achievement of spontaneous pregnancy by three times. Office hysteroscopy has an excellent sensitivity (>95%) for diagnosing intra-uterine lesions. Pelvic ultrasound, whose good sensitivity is improved by adding 3D imaging and hysterosonography, seems as efficient as office hysteroscopy in diagnosing uterine cavity abnormalities. Moreover, it also efficiently diagnoses pelvic diseases such as hydrosalpinx or endometrioma without laparoscopy. A first line laparoscopy is indicated in for woman suspected of endometriosis or tubal pathology (history of complicated appendicitis, previous pelvic surgery, pelvic inflammatory disease). For the others straight forward cases, the majority of patients, hysterosalpingography and pelvic ultrasound seem to be sufficient as primary diagnostic tool.
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Affiliation(s)
- A Torre
- Faculté de médecine Paris-Ouest, Université de Versailles Saint-Quentin en Yvelines, 9 boulevard d'Alembert, 78280 Guyancourt, France.
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Almog B, Shalom-Paz E, Shehata F, Ata B, Levin D, Holzer H, Tan SL. Saline instillation sonohysterography test after normal baseline transvaginal sonography results in infertility patients. Is it justified? Gynecol Endocrinol 2011; 27:286-9. [PMID: 20528569 DOI: 10.3109/09513590.2010.491570] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To investigate whether there is additional value for saline instillation sonohysterography (SIS) as a routine screening tool when baseline transvaginal sonography (TVS) is normal. METHODS Two-hundred ninety four infertility patients underwent baseline TVS and were categorised according to the results. TVS findings were negative in study group (n = 124) and positive (any abnormalities) in control group (n = 170). All the patients were further investigated by SIS. Hysteroscopy was performed whenever SIS results were suspicious. Our main outcome measure was accuracy of SIS in detecting intracavitary lesions using pathology reports as gold standard. RESULTS In the study group, out of 124 SIS tests, 13 (10.4%) showed positive findings and were further investigated by hysteroscopy. Three out of the 13 (23.0%) had subsequent positive hysteroscopy findings, however, no (0.0%) abnormality was found on pathologic examination. In the control group, out of 170 SIS tests, 62 (36.4%) showed positive findings, and were further investigated by hysteroscopy. Forty-two cases out of the 62 (67.7%) had subsequent positive hysteroscopic findings. Pathological examination was positive in 35 out of the 42 (83.3%) positive hysteroscopies. CONCLUSION Routine SIS for patients with normal TVS did not contribute additional findings. However, in patients with any suspicious findings on TVS (including extracavitary lesions), SIS was beneficial.
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Affiliation(s)
- Benny Almog
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, McGill Reproductive Center, McGill University Health Center, 687 Pine Avenue West, Montreal, Quebec, Canada.
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Jareethum R, Suksompong S, Petyim S, Prechapanich J, Laokirkkiat P, Choavaratana R. Efficacy of mefenamic acid and hyoscine for pain relief during saline infusion sonohysterography in infertile women: a double blind randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 2011; 155:193-8. [DOI: 10.1016/j.ejogrb.2010.11.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 10/20/2010] [Accepted: 11/29/2010] [Indexed: 11/26/2022]
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Aboulghar M, Shoeir I, Momtaz M, El Mohammady M, Ezzat H. A comparative study of 2-dimensional sonohysterography versus 3-dimensional sonohysterography in infertile patients with uterine cavity lesions and abnormalities. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2011. [DOI: 10.1016/j.mefs.2010.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Bingol B, Gunenc Z, Gedikbasi A, Guner H, Tasdemir S, Tiras B. Comparison of diagnostic accuracy of saline infusion sonohysterography, transvaginal sonography and hysteroscopy. J OBSTET GYNAECOL 2011; 31:54-8. [DOI: 10.3109/01443615.2010.532246] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Cakmak H, Taylor HS. Implantation failure: molecular mechanisms and clinical treatment. Hum Reprod Update 2010; 17:242-53. [PMID: 20729534 DOI: 10.1093/humupd/dmq037] [Citation(s) in RCA: 231] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Implantation is a complex initial step in the establishment of a successful pregnancy. Although embryo quality is an important determinant of implantation, temporally coordinated differentiation of endometrial cells to attain uterine receptivity and a synchronized dialog between maternal and embryonic tissues are crucial. The exact mechanism of implantation failure is still poorly understood. METHODS This review summarizes the current knowledge about the proposed mechanisms of implantation failure in gynecological diseases, the evaluation of endometrial receptivity and the treatment methods to improve implantation. RESULTS The absence or suppression of molecules essential for endometrial receptivity results in decreased implantation rates in animal models and gynecological diseases, including endometriosis, hydrosalpinx, leiomyoma and polycystic ovarian syndrome. The mechanisms are diverse and include abnormal cytokine and hormonal signaling as well as epigenetic alterations. CONCLUSIONS Optimizing endometrial receptivity in fertility treatment will improve success rates. Evaluation of implantation markers may help to predict pregnancy outcome and detect occult implantation deficiency. Treating the underlying gynecological disease with medical or surgical interventions is the optimal current therapy. Manipulating the expression of key endometrial genes with gene or stem cell-based therapies may some day be used to further improve implantation rates.
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Affiliation(s)
- Hakan Cakmak
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA
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Comparison of diagnostic accuracy of saline infusion sonohysterography, transvaginal sonography and hysteroscopy in postmenopausal bleeding. Arch Gynecol Obstet 2010; 284:111-7. [PMID: 20665218 DOI: 10.1007/s00404-010-1604-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Accepted: 07/12/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To compare the diagnostic accuracy of transvaginal sonography (TVS), saline infusion sonohysterography (SIS) and hysteroscopy (HS) with respect to pathological diagnosis in the detection of uterine cavity abnormalities associated with abnormal uterine bleeding among postmenopausal women. METHODS Being a prospective, investigator-blind trial, the present study was conducted on 137 postmenopausal women, with abnormal uterine bleeding, admitted to the Department of Obstetrics and Gynecology of Istanbul Bilim University, Florence Nightingale Hospital and Fertigyn Woman Health and IVF Center. After TVS, all patients underwent SIS using Cook Soft 500 IVF transfer catheter and HS, consecutively. Sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated to compare the diagnostic accuracy of TVS, SIS and HS. RESULTS Most commonly encountered endometrial lesions were polypoid lesion (38.0%) and hyperplasia (28.4%) among our study population consisting of 137 women (mean age 61.6 ± 9.6 years) in their postmenopausal stage. Overall sensitivity rates were 70.0% for TVS, 89.6% for SIS and 92.3% for HS, while the overall specificity rates were 50.0, 77.3 and 80.7%, respectively. HS had PPV of 96.2% and NPV of 65.3%, whereas PPV was determined to be 80.9 versus 95.3% and NPV was 35.4 versus 58.3% for TVS and SIS, respectively. CONCLUSIONS As an easy to perform, safe and well-tolerated procedure yielding high diagnostic accuracy, saline infusion SIS via this catheter seems to be superior to TVS and very close to HS. It may be used as the primary method for the detection of uterine abnormalities among postmenopausal women with abnormal uterine bleeding.
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El-Mazny A, Abou-Salem N, El-Sherbiny W, Saber W. Outpatient hysteroscopy: a routine investigation before assisted reproductive techniques? Fertil Steril 2010; 95:272-6. [PMID: 20638055 DOI: 10.1016/j.fertnstert.2010.06.033] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2010] [Revised: 05/25/2010] [Accepted: 06/14/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the importance of subjecting the patient to an outpatient (office) hysteroscopy (OH) before assisted reproductive techniques (ART) and patient compliance, possible side effects, and complications of the procedure. DESIGN Comparative observational cross-sectional study. SETTING University hospital. PATIENT(S) One hundred fifty-two patients attending the outpatient infertility clinic for pre-ART (IVF/intracytoplasmic sperm injection [ICSI]-ET) investigations, with normal uterine findings on hysterosalpingography (HSG). INTERVENTION(S) Transvaginal sonography (TVS) and OH (using a rigid, 30-degree, 4-mm hysteroscope) by the vaginoscopic "no touch" technique. MAIN OUTCOME MEASURE(S) Diagnostic value and compliance of OH. RESULT(S) The procedure was successful in 145 patients (95.4%); 51 of them (35.2%) had previous ART failures. Abnormal hysteroscopic findings were observed in 48 women (33.1%), in which endometrial polyp, submucous myoma, and intrauterine adhesions were the most common findings. The TVS was specific (100%) but not sensitive (41.7%) compared with OH. Abnormal hysteroscopic findings were significantly higher in patients with previous ART failure(s). The procedure was acceptable in almost all patients with no reported complications. CONCLUSION(S) The OH should be part of the infertility workup before ART even in patients with normal HSG and/or TVS. This is especially relevant in cases with prior failed ART cycles.
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Affiliation(s)
- Akmal El-Mazny
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Devroey P, Fauser BCJM, Diedrich K. Approaches to improve the diagnosis and management of infertility. Hum Reprod Update 2009; 15:391-408. [PMID: 19380415 PMCID: PMC2691653 DOI: 10.1093/humupd/dmp012] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Revised: 02/19/2009] [Accepted: 03/18/2009] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Recent advances in our understanding of the causes of infertility and of assisted reproductive technology (ART) have led to the development of complex diagnostic tools, prognostic models and treatment options. The Third Evian Annual Reproduction (EVAR) Workshop Meeting was held on 26-27 April 2008 to evaluate evidence supporting current approaches to the diagnosis and management of infertility and to identify areas for future research efforts. METHODS Specialist reproductive medicine clinicians and scientists delivered presentations based on published literature and ongoing research on patient work-up, ovarian stimulation and embryo quality assessment during ART. This report is based on the expert presentations and subsequent group discussions and was supplemented with publications from literature searches and the authors' knowledge. RESULTS It was agreed that single embryo transfer (SET) should be used with increasing frequency in cycles of ART. Continued improvements in cryopreservation techniques, which improve pregnancy rates using supernumerary frozen embryos, are expected to augment the global uptake of SET. Adaptation and personalization of fertility therapy may help to optimize efficacy and safety outcomes for individual patients. Prognostic modelling and personalized management strategies based on individual patient characteristics may prove to represent real progress towards improved treatment. However, at present, there is limited good-quality evidence to support the use of these individualized approaches. CONCLUSIONS Greater quality control and standardization of clinical and laboratory evaluations are required to optimize ART practices and improve individual patient outcomes. Well-designed, good-quality studies are required to drive improvements to the diagnosis and management of ART processes.
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Affiliation(s)
- P Devroey
- Center of Reproductive Medicine, Free University Brussels, Laarbeeklaan 101, Brussels 1090, Belgium.
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Yauger BJ, Feinberg EC, Levens ED, Gustofson RL, Larsen FW, DeCherney AH. Pre-cycle saline infusion sonography minimizes assisted reproductive technologies cycle cancellation due to endometrial polyps. Fertil Steril 2008; 90:1324-6. [DOI: 10.1016/j.fertnstert.2007.09.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2007] [Revised: 09/21/2007] [Accepted: 09/21/2007] [Indexed: 11/25/2022]
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Gera PS, Allemand MC, Tatpati LL, Galanits TM, Morbeck D, Coddington CC. Role of saline infusion sonography in uterine evaluation before frozen embryo transfer cycle. Fertil Steril 2008; 89:562-6. [PMID: 17517405 DOI: 10.1016/j.fertnstert.2007.03.067] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2006] [Revised: 03/21/2007] [Accepted: 03/21/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the role of saline infusion sonography (SIS) in uterine evaluation before a frozen embryo transfer (FET) cycle. DESIGN Retrospective cohort analysis. SETTING University hospital. PATIENT(S) Thirty-six patients who had uterine evaluation by SIS before FET cycle. INTERVENTION(S) The SIS was performed in the follicular phase of the menstrual cycle before the actual FET cycle. MAIN OUTCOME MEASURE(S) The SIS findings, clinical pregnancy rate (PR), ongoing PR, and correlation between positive SIS findings with and without subsequent treatment and pregnancy outcome. RESULT(S) Positive SIS findings were found in 11/36 patients (30.5%), which included uterine septum (9.0%), endometrial polyp (45.4%), intramural fibroid with normal cavity (9.0%), cystic endometrial changes (9.0%), cervical stenosis (18.1%), and calcification with normal cavity (9.0%). The overall clinical PR in all groups was 51.4%, with an ongoing PR of 45.7%. Patients with positive SIS finding who underwent subsequent hysteroscopic correction (7/11) had a clinical PR of 85.7% as compared to 54.1% in patients with normal uterine cavity (24/35). Patients with positive SIS findings and no operative hysteroscopy (4/11) had a clinical PR of 50% and pregnancy loss rate of 100%. CONCLUSION(S) Obtaining an SIS before the FET cycle can be helpful in the detection of uterine abnormalities. If time since uterine evaluation has been more than 1-2 years, performing an SIS is recommended as subsequent correction of the anomalies may improve FET outcome.
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Affiliation(s)
- Puja S Gera
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA
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Bozdag G, Aksan G, Esinler I, Yarali H. What is the role of office hysteroscopy in women with failed IVF cycles? Reprod Biomed Online 2008; 17:410-5. [DOI: 10.1016/s1472-6483(10)60226-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Batzer FR. Abnormal uterine bleeding: imaging techniques for evaluation of the uterine cavity and endometrium before minimally invasive surgery--the case for transvaginal ultrasonography. J Minim Invasive Gynecol 2007; 14:9-11. [PMID: 17218222 DOI: 10.1016/j.jmig.2006.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2006] [Accepted: 08/24/2006] [Indexed: 11/23/2022]
Abstract
Transvaginal ultrasound has been utilized for first line evaluation of abnormal uterine bleeding since its development in the early 1980's. The benefits and diagnostic effectiveness of transvaginal ultrasound in assessing the uterus, unlike hysteroscopy, extends to the complete pelvis. The ease of application, patient acceptance, and immediacy of results are rapidly apparent. Comparisons with hysteroscopic evaluation are discussed. While tissue diagnosis is still the gold standard, transvaginal sonography lets one know what surgical procedure to plan for from hysteroscopy to Endoscopy or laparotomy, including when no further surgical evaluation is necessary.
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A prospective evaluation of uterine abnormalities by saline infusion sonohysterography in 1,009 women with infertility or abnormal uterine bleeding. Fertil Steril 2006; 86:1731-5. [DOI: 10.1016/j.fertnstert.2006.05.044] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2006] [Revised: 05/12/2006] [Accepted: 05/12/2006] [Indexed: 11/15/2022]
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Current World Literature. Curr Opin Obstet Gynecol 2005. [DOI: 10.1097/01.gco.0000194327.87451.dd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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