BACKGROUND:Submucosal myomas are associated with infertility and may be treated by hysteroscopic resection.OBJECTIVE:The aim of this retrospective study was to analyze 37 subfertile patients who unnderwent hysteroscopic myomectomy in a tertiary care center with particular regard to their postprocedure reproductive outcome.MATERIALS AND METHODS:The entire patient group (n = 37) underwent the procedure between March 2004 and March 2010. The submucosal myomas were type 0 (n = 27), type 1 (n = 8), and type 2 (n = 2). The mean myoma size was 2.1 cm; mean duration of the procedure was 54 mins and mean follow-up was 26 ± 10 months. 22 patients had one or more associated infertility factors.RESULTS:The complication rate was 5.4%. 11 patients (29.7%) conceived after the procedure. The pregnancy rate was better when myoma was the exclusive etiology of infertility (40%), when the myoma was completely intracavitary (33.3%), when the lesion was ≥ 30 mm in size (50%), and there were no associated intramural fibroids.CONCLUSION:Hysteroscopic myomectomy is a safe procedure to enhance fertility especially in cases with unexplained infertility.

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Background: Transvaginal ultrasonography and hysteroscopy are the tools to assess the inner architecture of the uterus.In India as such very few studies were conducted to see the effect of endometrial injury on the pregnancy outcome, so the current study was conducted to assess the efficacy of hysteroscopy in identifying the uterine pathologies and to assess the pregnancy rate following the endometrial scratching. Methods: A prospective cohort study was conducted during June 2012 to may 2015 at KJK Hospital, Trivandrum. All patients undergoing IVF in the said duration are scheduled for Pre IVF Hysteroscopy prior to the onset of periods. All the study population had undergone a transvaginal USG and hysteroscopy. Half of the study population (n=175) had underwent endometrial scratching and the occurrence of clinical pregnancy was compared among the group who had not undergone the endometrial scratching. Results: The sensitivity (100%) and specificity (85%) was much higher for hysteroscopy when compared with USG. There was a statistically significant difference in the occurrence of clinical pregnancy among the patients for whom endometrial scratching done when compared to those who had not undergone endometrial scratching (p<.0001). Conclusions: Through hysteroscopy, the intrauterine pathologies and structural uterine abnormalities that may be responsible for the failure of IVF can be detected and treated, resulting in improved pregnancy rates and the clinical pregnancy and implantation rates significantly increase after endometrial scratching in same cycle in patients with good-quality embryos.

INTRODUCTIONIntrauterine insemination (IUI) is the therapeutic process of placing washed spermatozoa transcervically into the uterine cavity for the treatment of infertility. IUI theoretically allows a relatively higher number of motile spermatozoa to reach the oocyte and it has been used for a variety of indications such as non-severe male factor infertility, unexplained infertility, cervical mucus hostility, ovulatory disturbances, mild endometriosis, antisperm antibodies and male sexual dysfunctions like impotency, hypospadias, and retrograde ejaculation. [1][2][3][4] The rationale behind IUI is increasing the gamete density at the time and site of potential fertilization i.e., increasing the chances of spermatozoa meeting the oocyte in the fallopian tube after ovulation has occurred. IUI is generally considered as an intermediate step of low to moderate complexity before the application of more sophisticated assisted reproductive technologies (ART) such as IVF with or without ICSI.The overall success rates of IUI remains controversial and depends on several factors, with published pregnancy rates varying from as low as 5% to as high as 70% per patient, however a 10%-20% clinical pregnancies per cycle is an acceptable range for all aetiologies.2 The pregnancy rates per IUI cycle are quite variable in the literature due to differences in cause and duration of infertility, type of ovarian stimulation, sperm preparation techniques, treatment cycles and number of times IUI is performed during a cycle (single or double). Results:The overall pregnancy rate was 15.2%. Among the predictive factors evaluated, the infertility diagnosis (PCO and male factor, p value <0.001), the post wash semen count (5-10 million, p value <0.001), type of IUI (double IUI over single IUI, p value <0.001) and the endometrial thickness on the day of trigger (9-10mm, χ2 =551.59 df =5 p<0.001) significantly influenced the pregnancy rate. Conclusions: IUI is a successful contemporary treatment for appropriately selected cases of PCO and male factor infertility, especially when female age is <35 years.

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