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HYSTEROSCOPY FOR
INFERTILE PATIENT
An Evidence Based Approach
Dr.Mohamed El Sherbiny
MD Obseri!s"#yne!olo$y
Senior Cons%lan
Damiea #eneral Hos&ial
Damiea E$y&
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DIAGNOSTIC
HYSTEROSCOPY
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SHOULD HYSTERSCOPY
BE DOE ROUT!LY !
THE E"ALUAT!O
O# !#ERT!L!TY $
O
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Indi!aions o' Dia$nosi! Hyseros!o&y
'or Re&rod%!i(e Fail%re
A%norma& h'sterosa&pin(o(ram.
A%norma& )terine %&eedin(
S)spected intra)terine patho&o('
Uterine anoma&ies
Pre(nanc' wasta(e
Une*p&ained in+erti&it'
)alle *++,
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SHOULD HYSTEROSCOPY
BE USED ROUTINELY AT THE
TIME OF LAPAROSCOPY FOR .
THE INVESTIGATION OF .
INFERTILIY ?
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El Sherbiny M- Medi!al . o' Cairo /ni(.- )ol.,0 No. 1- Se&. *++2
El Sherbiny M- The 2h Ann%al Meein$ O' The Inern. So!iey 'or
#yne!olo$i! Endos!o&y -S%n Ciy- So%h A'ri!a3*04*5 Mar!h-*++5
Hyseros!o&y done a
la&aros!o&y
ime- has lo6 !om&li!aion rae-
hi$h de$ree o' sa'ey- minimal ime
re7%iremen and adds lile
e7%i&men " !os.
Posii(e hyseros!o&i! 'indin$s
6ere 'o%nd in many !ases 8*09:
des&ie ha(in$ normal HS# and no
s%$$esi(e hisory o' %erine lesion
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Unexplained infertility
Small endometrial polyp
Small cervical polyp
Adhesion at cornual cones
Cornual polyp
Endometrial dystrophies
(atrophy or hyperplasia) that
may affect receptivity or
implantation especially in ART.
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Une*p&ained in+erti&it'
,
Corn)a& po&'p
cervica& po&'p
HS# is 'ree
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OPERATIVE
HYSTEROSCOPY
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Indi!aions o' O&erai(e Hyseros!o&y
'or Re&rod%!i(e Fail%re
Po&'p.
S)%m)co)s &eiom'oma.
Uterine septa.
!ntra)terine Adhesions.
-isp&aced or em%edded !UD
T)%a& cann)&ation . #a&&oposcop'.
)alle *++,
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36 38
Uterine Polyp
Sonoh'stero(raph'
Hyseros!o&y
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!ntra)terine
s'nechiae
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HSG: Filling defect
Stellate & irregular,
Commonly inhomogeneous
HYSTEROSCOPY
Confirmation
Evaluation of the extent of the disease
!ntra)terine S'nechiae
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The Ameri!an Feriliy So!iey !lassi'i!aion o'

inra%erine adhesions.*+55.
E;en o' < *=1 *=1 > ?=1 @?=1
Ca(iy In(ol(ed * ? A
Ty&e o' Filmy 'ilmy " Dense Dense
Adhesions * ? A
Mensr%al Normal Hy&omenorrhea Amenorrhea
Paern B ? A
Sa$e I 8Mild: * / A
Sa$e II 8Moderae 0 / 5
Sa$e III 8Se(ere: + / *?
Com%ined HS0
. h'steroscop'
. c&inica&
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!ntra)terine S'nechiae
Se(ere
Moderae
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Septate Uter)s 1
"a&)e o+ H'steroscop'

Confirming the abnormality

Evaluating the uterine cavity capacity

Discarding other pathologic findings

such as polyps, endometritis,
hypertrophy

uiding surgical aproach

Traver et a&. !n+erti&it' in the 2
rd
-i&&enni)m Pra()e3 4555
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Resection o+ the Uterine Sept)m
121
La&aros!o&i! #%ided
Se&%m
CollinCs
Ele!rode
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!roximal
"ubal
#bstruction
$!"#%
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!roximal "ubal #bstruction

#i%rosis o%&iteration.S! 657

Endometriosis .Corn)a& po&'p 857

Corn)a& spasm 457

Amorpho)s materia& 957

"isco)s secretions 257

-)cosa& a((&)tination

Stroma& edema
)alle *++,
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Oi&/so&)%&e "ers)s :ater/so&)%&e -edia
+or H'sterosa&pin(o(raph'
Flushing of the tubes with oil-soluble media
increases subsequent pregnancy rates in
infertility patients.
It may flush tubal "plugs" that are a cause of
proximal tubal occlusion .
Clinicians should consider flushing the tubes
with OSC before contemplating more
in!asi!e therapies.
"ande#erc#ho!e et al., July 1996 $Cochrane %e!iew&.
In: The Cochrane Library, Issue 2 2002. Oxford: Update Software.
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T%bal CaheeriDaion
:here pro*ima& t)%a&
o%str)ction is s)spected3
and there are no other t)%a&
a%norma&ities3 a t)%a&
catheterisation proced)re
ma' %e attempted
RCO0 0)ide&ines 1 0rade B Recommendation
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T%bal CaheeriDaion
Eilaeral Corn%al Elo!F
Amorpho)s materia&
R. O(ary
R. 'imbria
Corn%al !aheeriDaion
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Thank You