Creating a microhole on the zona pellucida of the oocyte by laser beam prior to ICSI provides a less traumatic penetration of the injection needle into the ooplasm and results in lower degeneration and higher embryo development rates than C-ICSI in patients with fragile oocytes.
Research supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG). The authors have nothing to disclose.
Objective:The aim of this study was to verify the prevalence of uterine cavity
abnormalities diagnosed by routine office hysteroscopy in women preparing to
IVF.Methods:We carried out a retrospective cross-sectional study of 1141 consecutive
women who underwent outpatient hysteroscopy before IVF at a tertiary
academic center. Of these, 961 participants had a normal transvaginal
sonography (TVS) of the uterine cavity. The prevalence of hysteroscopic
alterations in successive age strata was submitted to Mantel-Haenzsel
Chi-square test for linear trend. The diagnostic accuracy of TVS using
hysteroscopy as reference was assessed by calculating the sensitivity,
specificity, positive and negative likelihood ratios.Results:Hysteroscopic alterations were present in 265/961 of patients with a negative
TVS (prevalence 27.6%, 95% confidence interval [CI]
24.8%-30.5%). The prevalence of unsuspected submucous leiomyoma was higher
among older women (p=0.005, chi-square test for linear
trend) and reached 7.2% (95% CI 3.5%-14.1%) after 40 years. The sensitivity
of TVS ranged from 8% (95% CI 2%-20%) for uterine synechiae to 41% (95% CI
28%-56%) for submucous leiomyoma, resulting in low likelihood ratios for
negative TVS results.Conclusions:These findings suggest a high prevalence of unsuspected alterations found by
routine hysteroscopy before IVF, an age-dependent increase in the frequency
of submucous leiomyoma and a low diagnostic sensitivity of TVS to detect
intracavitary lesions.
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