Background: The success rates of in vitro fertilisation (IVF) cycles have remained low. The condition of the uterus plays a significant role in the IVF treatment outcome. Unfortunately, some uterine pathologies are missed on routine ultrasound scans performed before IVF. Objective: To document the hysteroscopy findings following normal ultrasound scan endometrial assessments in women with two previous failed IVF cycles, seen at a private fertility unit. Materials and Methods: This is a retrospective descriptive study. The electronic medical records were retrieved for patients who underwent hysteroscopy after two consecutive failed IVF cycles despite normal ultrasound scan findings between April 1, 2010, and March 31, 2017. Data, including age, findings at hysteroscopy, and IVF/intracytoplasmic sperm injection treatment outcomes following hysteroscopy, were documented. The results are presented as frequency distribution tables. Results: A total of 77 patients had normal ultrasound scan findings after two previous failed IVF cycles, requiring a hysteroscopy during the study period. This represented 7.7% of the 1,002 hysteroscopies performed during the same period. The age range was 25–54 years, with a mean age of 37 ± 4.3 years. A majority of the women (59, 76.6%) had no pathology on hysteroscopy, while 14 (18.2%) had intrauterine adhesions. Three patients (3.9%) had endometrial polyps, and one patient (1.3%) had a subseptate uterus. Following hysteroscopy, 24 patients (31.2%) became pregnant, 29 patients (37.6%) had failed IVF cycles, while the remaining 24 patients (31.2%) were lost to follow up. Conclusion: This study has added to the body of evidence that suggests that routine hysteroscopy before IVF is capable of picking up missed pathologies that might otherwise negatively impart IVF success rates. More RCT are, however, needed to determine the effect of routine hysteroscopy on IVF treatment outcomes.
Objective: To report our experience over a 7-year period, in establishing a low-budget hysteroscopy unit in the Niger-Delta region of Nigeria. Design: A retrospective descriptive study. Settings: A private dedicated fertility unit. Patients: All patients who had hysteroscopy performed during the period under review. Interventions: The trolley (cart) was made by a technician, and home television sets served as monitors. Because of the frequent power surge, we used a back-up portable, handheld LED light source. The camera unit was initially a single chip model. The hysteroscope was a "demo" version, the hysteroscopic forceps and scissors were the detachable variety, thereby reducing maintenance costs. The manual pump with an attached gauge was used for delivering fluids from 1liter normal saline bags for minor procedures, while sterile urine bags were improvised for retaining more normal saline infusions for bipolar resections. Measurements/Results: A total of 1,002 hysteroscopic procedures were performed between April 2010 and March 2017. The majority of the patients (979 or 97.7%) presented with infertility. The most common indication for hysteroscopy was intrauterine adhesion (475 or 47.4%). There were 26 cases (2.59%) of retained fetal bones within the endometrial cavity. The most common surgical procedure performed was intrauterine adhesiolysis (483 or 48.2%), while hysteroscopic polypectomy and myomectomy accounted for 15.0% and 5.6% of the total procedures performed respectively. There were four cases of inadvertent uterine perforation, one case with glycine fluid overload. Four cases were canceled as the patients could not tolerate the office procedures because of excruciating pain. Conclusions: Hysteroscopy is possible in a low-resource setting. Numerous innovative ways at circumventing some of the expensive equipment might encourage practitioners in low-resource settings to spread this important technology.
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