Evaluation of uterine cavity by office hysteroscopy used in infertility work-up Péter Török MD, PhD University of Debrecen, Clinical Center Department of Obstetrics and Gynecology C

This work was supported by the project SCOPIA – Development of software supported clinical devices based on endoscope technology (VKSZ_14-1-2015-0072). The project was supported by the Hungarian Government and financed by the National Research, Development and Innovation Fund.

Background Hysteroscopy is stated as the gold standard method in evaluating the uterine cavity Indications infertility abnormal uterine bleeding recurrent miscarriage sups. intrauterine pathology by other imaging method

Office hysteroscopy No Anesthesia No OR No Hospitalization Out-patient setting

Instruments Optic: 2.9 mm, 30 degree, rigid 3.7 mm single flow sheath 5.5 mm operative sheath, with in-built working channel (EMD Endoscope Technology) Distension medium: saline, at pressure of 80-100 Hgmm ^ Light source:150 W, halogen Digital camera (USB) ^ Cooper, N.A.M., Smith, P., Khan, K.S. et al.: A systematic review of the effect of the distension medium on pain during outpatient hysteroscopy Fertil Steril. 2011 Jan; 95(1):264-7

Patients Between 01.05.2008. and 01.12.2011. 400 examinations Successful in 395 cases Infertility: 226 cases Negative USG! No major complication: bleeding, perforation

Methods Lithotomy position Without anesthesia Early follicular phase, between 4-5th and 10-11th cycle-day Modified „no-touch” technique ^ Cusco instrument disinfection without grabbing and dilating cervix Duration: 2-5 minutes, no need for hospitalization ^ Sharma, M., Taylor, A., di Spiezio Sardo, A., et al.: Outpatient hysteroscopy: traditional versus the ‘no-touch’ technique. BJOG 2005, 112, 963–967

226 case in infertility Mean age: 33.2 years Intrauterine pathology in 80 cases (36%!) Primary infertility 60.7% Secondary infertility 39.3% Secondary infertility 56% nulliparous, 44% non-nulliparous

Findings Endometrial polyp: 29 cases Myoma: 11 cases Septated uterus (in one case simultaneous myoma): 26 cases Arcuated uterus (in 2 cases simultaneous myoma): 10 cases Endometrial pathology: 6 cases

Patients with negative results: 32.6 years Patients with positive results: 35.1 years.

Conclusion Opportunity of a quick, precise, minimally invasive evaluation of the uterine cavity. Because of infertile problems, more and more hysteroscopy is indicated all over the world. Any type of intrauterine pathology: 36% of cases, that was not suspected before OHSC simple to perform cost-effective Office hysteroscopy is recommended to perform at the beginning of the infertility work-up!