Implementation of hysteroscopy in an infertility clinic: The one-stop uterine diagnosis and treatment

Abstract

Magnetic Resonant Imaging (MRI) has demonstrated that we can differentiate the uterus in 3 important functional areas. Exploration of the uterus in the infertile patient should implement the evaluation of the endometrium, the Junctional zone myometrium (JZ), the outer myometrium and the cervical canal. Especially the JZ myometrium should receive our close attention in the exploration and treatment of the infertile patient. MRI cannot be implemented as a screening examination but also limiting the imaging of the womb to a 2 or 3 D ultrasound exam only does not meet the scientific requirements of sensitivity and specificity. Modern ambulatory uterine diagnosis in a one-stop approach includes transvaginal ultrasound, fluid mini Hysteroscopy, contrast sonography and endomyometrial tissue sampling. Transvaginal Ultrasound being the gold standard for global uterine screening has a cardinal importance for diagnosis of myometrial disorders and uterine congenital malformations whereas hysteroscopy remains the gold standard for the evaluation of the endometrium and cervical canal. The major challenge remains to perform a tissue sampling of the endo-myometrium in an ambulatory, patient friendly and reliable way for which the newly designed Trophy hysteroscope provide a satisfactory answer. This one-stop approach opens a total new and advanced dimension to the screening, diagnosis and treatment of uterine pathology in the infertile patient.

Keywords: Ambulatory; MRI; diagnosis; hysteroscopy; infertility; one-stop approach; sonography; tissue sampling; ultrasound.

Fig. 1. Magnetic resonance imaging demonstrating the 3 functional zones of the uterus.(1) Endometrium, (2) Junctional zone myometrium, (3) Outer myometrium.

Fig. 2. Trophy hysteroscope (1) with diagnostic (2) and operative (3) accessory sheet. Diagnostic sheet in active position providing double flow after visual controlled dilatation (4).

Fig. 3. 5 French instruments used with the Trophy hysteroscope.

Fig. 4. One stop uterine diagnosis.

Fig. 5. Hysteroscopic findings, mayor pathologies. (1) Myoma, (2) (3) Endometrial polyp, (4) Uterine septum, (5) Intrauterine adhesions, (6) Placental remnants.

Fig. 6. Incidence of findings at hysteroscopy in the infertile and abnormal uterine bleeding patients. Subtle lesions clarification 1. Mucosal elevation, 2. Strawberry pattern, 3. Polyposis, 4. Necrotic tissue, 5. Synechiae.

Fig. 7. Subtle lesions.(1) Focal hypervascularization, (2) Cavity deformation, (3) Mucosal elevation.