1. 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

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

3. 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

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

5. 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 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 Jan; 95(1):264-7

6. 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

7. 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

8. 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

9. 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

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

14. 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!