Uterine alterations in women undergoing routine hysteroscopy before in vitro fertilization: high prevalence of unsuspected lesions

Abstract

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.

Hysteroscopic alterations in women with infertility or recurrent spontaneous abortion in case of normal transvaginal ultrasonography

“…This study found that the prevalence of hysteroscopic diagnoses of submucous leiomyoma increased gradually with age. This result is consistent with previous studies stating that even if there are no abnormalities on TVS, female patients over the age of 40 years are more likely to develop submucous leiomyoma during hysteroscopy [15] . Previous studies have shown that the diagnostic rate of common TVS in the screening for uterine malformations is high.…”

“…Monteiro and colleagues conducted routine hysteroscopy in Brazilian patients preparing for in vitro fertilization to study the prevalence of unexpected uterine cavity abnormalities. The study also assessed the age-related prevalence of lesions and the accuracy of TVS in detecting the most common hysteroscopic lesions [15] .…”

<p>The Impact of Spinal Anesthesia and Use of Oxytocin on Fluid Absorption in Patients Undergoing Operative Hysteroscopy: Results from a Prospective Controlled Study</p>

“…The combination of transvaginal U/S and hysteroscopy was recommended to plan an appropriate management of intrauterine disease. 7,8 According to an overview by Di Spiezio Sardo et al, none of the available methods for endometrial evaluation was ideal and each one has pros and cons. 9 In our hospital, almost all our cases of operative hysteroscopy were performed using monopolar resectoscope and glycine distension medium.…”

Restricted access to assisted reproductive technology and fertility preservation: legal and ethical issues

“…Only in 2012, the Ministry of Health allocated financial resources to public hospitals that had been caring out infertility treatments for years without any specific reimbursement for the ART procedures (Brasil, 2012). This ordinance granted eight public clinics in five states of the country with a single deposit of BRL 1.5 M (USD 750,000 at that time), which covered the budget of just 13 months or 206 IVF cycles in our center in Belo Horizonte (Monteiro et al, 2019). Unfortunately, the ordinance was not renewed and the funds were never granted again.…”

“…Unfortunately, the ordinance was not renewed and the funds were never granted again. This chronic underfunding illustrates the need to impose strict criteria to admit and keep patients in the handful of public hospitals that offer free ART in the country, which are still unable to shorten the wait lists and the waiting time for users, typically above 5 years (Monteiro et al, 2019).…”