The role of diagnostic hysteroscopy in infertile women

Anomalies of the uterus are considered one of the reasons for infertility in women. For this reason we believe diagnostic hysteroscopy is fundamental in screening for infertility. The aim of this study was to verify the incidence of uterine anomalies in sterile couples and evaluate the efficacy of diagnostic hysteroscopy in subjects with possible alterations in this organ.

From July through December 2000, 296 hysteroscopies were carried out at the Centro di Sterilità e di Fecondazione Assistita of Perugia University. Of these 223 entered the study because of infertility in couples. The exam was always done between the 7th and 11th day of the cycle using a Hamou 5 mm hysteroscope, without anaesthesia. The uterus was dilated by introducing physiological solution at 50 mmHg pressure. The criteria adopted for hysteroscopic findings were based on: a) cervical canal; b) uterine cavity; c) endometrium, and visualization of the ostium tubae.

Of the 223 women who underwent hysteroscopy screening for infertility 17 (7.62%) had uterine anomalies. Of these 1 was in the cervical canal, 4 had anomalies in both the uterus and cervix, and the remaining 12 had only uterine cavity anomalies. The presence of neoformations was the most commonly found alteration.

From the results of this study we conclude that diagnostic is a very important method for investigating the reasons for infertility in a couple. From our casuistry the incidence of uterine anomaly is 7.62%. We therefore suggest hysteroscopy be included among the 1st and 2nd level exams for female infertility.