Hysteroscopic evaluation in infertility and abnormal uterine bleeding

Navneet Kaur, Ruby Bhatia, Paramjit Kaur, Surinder K. Bhopal


Background: Hysteroscopy an endoscopic procedure for visualization of uterine cavity may be extensively used in both primary and secondary infertility and abnormal uterine bleeding for evaluating intrauterine pathology. The objectives of this study were to visualize and identity intrauterine pathology in both primary and secondary infertility and abnormal uterine bleeding (AUB) by hysteroscopic evaluation and to perform hysteroscopic guided therapeutic procedures like endometrial currettage, polypectomy, adhesiolysis.

Methods: Hysteroscopic evaluation of uterine cavity for any intrauterine pathology in AUB and Infertility. Adhesiolysis, polypectomy, endometrial biopsy misplaced copper T removal were carried out under hysteroscopic vision.

Results: Intrauterine synechia in 20.51%, Submucous fibroid in 5.13%, bicornuate uterus, endometrial hyperplasia and endometrial polyp were seen in 2.56% patient each were detected in infertility group while 81.95% cases with AUB had abnormal intrauterine pathology commonest being endometrial hyperplasia in 33.33% followed by endometrial polyps in 23.81% cases, submucous fibroid and misplaced copper T in 9.52% each and intrauterine synechia in 4.76% patient. Endometrial biopsy and polypectomy was done in 23.80% each with AUB, misplaced copper T removal in 9.52% and adhesiolysis in 4.76% patient with AUB.

Conclusions: Hysteroscopy remains gold standard for evaluating intrauterine lesions in abnormal uterine bleeding and infertility. A safe, simple minimally invasive procedure not only diagnostic but therapeutic modality for adhesiolysis, endometrial biopsy/curettage, polypectomy, misplaced copper T removal under direct vision with minimal complication within reach of every Gynaecologist thereby reducing burden of major surgical intervention.


Abnormal uterine bleeding, Hysteroscopy, Primary infertility, Secondary infertility

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Dongar VH, d kroon CD, Jacobi CE, Trimbos JB Jansen FW. Diagnostic hysteroscopy in abnormal uterine bleeding: a systematic review and meta-analysis. BJOG. 2007;114(6):664-75.

Bakour SH, Jones SE, O' Donovan P. Ambulatory hysteroscopy; evidence based guide to diagnosis and therapy. Best Pract Res Clin Obstet Gynaecol. 2006;20(6):953-75.

Refai AMN, Anderson T, Cheah SS. Outpatient hysteroscopy: findings and decision making for treatment of abnormal uterine bleeding in pre-and post-menopausal women. Middle East Fertility Society J. 2005;10(1):43-8.

Guin G, Sandhu SK, Lele A, Khare S. Hysteroscopy in evaluation of abnormal uterine bleeding. J Obstet Gynaecol India. 2011;61(5):546-9.

Asaad AOA, Awwad AM. Hysteroscopy: the gold standard diagnostic and therapeutic tool in Gynaecology. Our experience at Queen Alia Hospital, Jordan. Middle East J Family Med. 2012;10(9):1-4.

Feng L, Li D. Evaluation of intrauterine disorders by hysteroscopy and transvaginal sonography. Gynaecol Endoscopy. 2002;11(6):401-4.

Shveiky D, Rojansky N, Ravel A, Benshushan A, Laufer N, Shushan A. Complications of hysteroscopic surgery: beyond the learning curve. J Minimally Invasive Gynaecol. 2007;14(2):218-22.

Sardo AD, Taylor A, Tsirkas P, Mastrogamvrakis G, Sharma M, Magos A. Hysteroscopy: a technique for all? Analysis of 5,000 outpatient hysteroscopies. Fertility and sterility. 2008;89(2):438-43.

Patil SK, Daver RG. Hysteroscopy in excessive uterine bleeding. J Obst Gynaecol India. 1993;43(4):605-10.

deWit AC, Vieugels MPH, de Kruif JH. Diagnostic hysteroscopy; a valuable diagnostic tool in the diagnosis of structural intracavital pathology and endometrial hyperplasia or Carcinoma? Eur J Obstet Gynaecol Reprod Biol. 2003;110(1):79-82.

Kapur K, Biswas M. Office Hysterscopy. J Obstet Gynaecol India. 2005;55(2):174-7.

Nawroth F, Foth D, Schmidt T. Mini hysteroscopy as routine diagnostic procedure in women with primary infertility. J Am Asso Gynaecol Laparoscopists. 2003;10(3):396-8.

Shereiar NK, Walvekar VR, Bhathena RK, Daftary SN. Combined premenstural D&C, lapro hysteroscopy in the investigation of infertility. J Obstet Gynaecol India. 1991;41(6):807-11.

Prakash A, Sharma K, Choudhary V. The role of hysteroscopy in evaluation of infertility. J Obstet Gynaecol India. 2000;50(6):83-5.

Motashaw ND, Dave S. Diagnostic and therapeutic hysteroscopy in the management of abnormal uterine bleeding. J Reprod Med. 1990;35(6):616-9.

Zlatkov V, Burzakov G, Cholakova A, Miloshov V, Radeva V, Velinov E, et al. Diagonostic possibilities of the flexible hysteroscopy in irregular uterine bleeding. Akush Ginekol (Sofiia). 2006;45(1):36-40.

Patel SG, Bhute SB, Inamdar SA, Shrivastava DS. Role of diagnostic hysteroscopy in abnormal uterine bleeding and its histopathological correlation. J Gynecol Endoscopy Surg. 2009;1(2):105-12.