Laparoscopy and hysteroscopy in the diagnosis of female sterility

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Introductions. There has been huge progress in diagnosis and treatment of female sterility recently. Assisted reproductive technologies have become more available for couples who have no children. In Kirov region with population of about 1,5 mln people statistically 47,000 families suffer from sterility.

Material and methods. 232 operations have been performed for different causes in patients with sterility in our department from January 2002 to December 2004. The age of the patients was 21-43 years. At pre-operative stage the patients underwent the generally accepted methods of evaluation including multiple ultrasound evaluation, hormonal profile, hysterosalpingography. The duration of sterility varied from 1 to 20 years.

Results. Regardless the previously performed invasive methods of evaluation of primary and secondary sterility, in our opinion, all laparoscopic diagnostic and surgical procedures in patients with sterility should be combinated with hysteroscopic evaluation of uterine cavity. With hysteroscopy performed during operation we can detect endometrial pathology that was not diagnosed during the pre-operative stage and using ultrasound method. The following endometrial pathologies in patients with sterility have been detected by us: chronic endometritis - 12 cases (5%), endometrial

polyps - 32 cases ( 13,8%), mycropolyps under 5 mm in the region of tubal angle - 4 cases (1,7%), endometrial hyperplasia including nidal hyperplasia - 24 cases (10%), synechia of uterine cavity - 5 cases (2,17%), submucous myomatous nodes - 3 cases (1,3%), endometrial adenomatosis detected during hystologic evaluation of a deliberately chosen endometrial area - 3 cases (1,3%).

Conclusions. Thus, in 35,7% of cases we detected endometrial pathology in patients with sterility during hysteroscopy and laparoscopy. Hysteroscopy helps not only detect endometrial pathology but evaluate uterine cavity, the accordance of endometrium to the phase of menstrual cycle, detect an occlusion in the area of tubal angles, carry out intra-operative catheterization of tubes. In case of combination of 2 methods of evaluation we always administer IV antibacterial drugs 1 -2 hours before the operation or during the operation. Infectious complications have never occurred. We consider such way of performing endoscopic evaluation in sterile patients justified, even in the absence of ultrasound signs of endometrial pathology, it allows to shorten the time of evaluation of females with sterility, to detect non- obvious endometrial pathology, to administer the best course of therapy.

About the authors

E. G. Zaitseva

Kirov Regional Clinic, the Centre of minor -invasive surgery of Kirov Clinic № 6 “Lepse”
Kirov; Kirov

Author for correspondence.
Email: info@eco-vector.com
Russian Federation, Kirov; Kirov

А. G. Marenin

Kirov Regional Clinic, the Centre of minor -invasive surgery of Kirov Clinic № 6 “Lepse”
Kirov; Kirov

Email: info@eco-vector.com
Russian Federation, Kirov; Kirov

V. K. Biteev

Kirov Regional Clinic, the Centre of minor -invasive surgery of Kirov Clinic № 6 “Lepse”

Email: info@eco-vector.com
Russian Federation, Kirov; Kirov

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