Acurácia da histerossonografia versus ultrassonografia transvaginal em mulheres inférteis candidatas às técnicas de reprodução assistida

Abstract

A cavidade uterina foi considerada anormal quando se visualizava: endométrio com espessura superior à esperada para a fase do ciclo; pólipo endometrial; mioma submucoso e alteração do formato da cavidade do útero. A análise estatística foi feita utilizando-se frequências absolutas, valores percentuais e o teste χ 2 com nível de significância de 5%. RESULTADOS: Observamos que 92 (76,7%) mulheres inférteis, candidatas à TRA, apresentavam cavidade uterina normal pela HSN e em 28 (23,3%) foram detectadas as seguintes alterações: 15 pólipos (12,5%), nove alterações no formato da cavidade uterina (7,5%), 6 miomas submucosos (5%), 4 espessura endometrial anormal (3,3%) para a fase do ciclo menstrual e 2 septos uterinos (1,7%); 5 mulheres apresentavam mais de uma alteração (4,2%). Enquanto a USG observou alterações da cavidade uterina apenas em 5 (4,2%) mulheres, a HSN confirmou 4 das 5 alterações detectadas pela USG e detectou alterações na cavidade uterina em outras 24 mulheres que não tinham sido detectadas na USG, ou seja, a HSN foi capaz de detectar mais alterações na cavidade uterina do que a USG, com diferença significativa (p=0,002). CONCLUSÃO: A HSN tem maior acurácia que a USG na avaliação da cavidade uterina, neste grupo de mulheres inférteis candidatas às TRA. A HSN poderá ser facilmente incorporada à propedêutica das candidatas às TRA e contribuir para reduzir as falhas de implantação embrionária. Abstract PURPOSE:To compare the diagnostic accuracy of sonohysterography (HSN) and conventional transvaginal ultrasound (USG) in assessing the uterine cavity of infertile women candidate to assisted reproduction techniques (ART). METHODS: Comparative cross-sectional study with 120 infertile women candidate to ART, assisted at Centro de Reprodução Assistida (CRA) of Hospital Regional da Asa Sul (HRAS), Brasília -DF, from August 2009 to November 2010. Sonohysterography was performed with saline solution infusion in a close system. The sonohysterography finding was compared to previous USG results. The uterine cavity was considered abnormal when the endometrium was found to be thicker than expected during the menstrual cycle and when an endometrial polyp, a submucous myoma and an abnormal shape of the uterine cavity were observed. The statistical analysis was done using absolute frequencies, percentage values and the χ 2 , with the level of significance set at 5%. RESULTS: HSN revealed that 92 (76.7%) infertile women candidate to ART had a normal uterine cavity, while 28 (23.3%) had the following abnormalities: 15 polyps (12.5%),

An overview of the results of hysterosonography prior to in vitro fertilization

“…IVF was performed in five patients not submitted to hysteroscopy, since small polyps were deemed unable to interfere with treatment outcomes ( Check et al ., 2011 ). In agreement with our study, other authors also described endometrial polyps as the most prevalent finding (12.5%) ( Vilela et al ., 2012 ). However, other studies reported that submucous myomas (18.1%) were found more frequently than endometrial polyps (13.6%) ( Gupta et al ., 2016 ).…”

“…Only 1% of the hysterosonograms revealed the presence of submucous myomas, yielding a lower prevalence than the rates reported in literature, which range between 5% and 18% ( Gupta et al ., 2016 ; Sitimani et al ., 2016 ; Vilela et al ., 2012 ). When ultrasound examination found unequivocal evidence of a submucous component in the myomas, the patients were referred directly to hysteroscopy.…”

“…However, its diagnostic accuracy is low for the detection of pathologies of the uterine cavity such as polyps, synechiae and submucous myomas ( Ragni et al , 2005 ; Bingol et al ., 2011 ). Endometrial and/or uterine abnormalities not detected by TUS are present in 10-30% of infertile and asymptomatic women ( Vilela et al ., 2012 ). Hysterosonography (HSNG) was developed to improve the diagnosis of these conditions.…”

“…Some of the factors contributing to the dissemination and acceptance of the technique include the fact that it is less painful, less expensive, less invasive, and requires a shorter learning curve when compared to hysteroscopy ( Abou-Salem et al ., 2010 ; Bartkowiak et al ., 2006 ; Farquhar et al ., 2003 ). Thus, it may be indicated in the evaluation of the uterine cavities of women scheduled to undergo IVF treatments ( Vilela et al ., 2012 ).…”