الفهرس | Only 14 pages are availabe for public view |
Abstract Implantation failure could be due to a variety of reasons, including embryo quality and uterine receptivity, but remains unexplained in many cases. It represents a major cause of stress to both the clinician and the patient undergoing intracytoplasmic sperm injection (ICSI) cycle. Even minor uterine cavity abnormalities, such as endometrial polyps, small submucous myomas, adhesions, and septa are considered to have a negative impact on the chance to conceive. The presence of uterine pathology may negatively affect the chance of implantation. The prevalence of unsuspected uterine pathology in asymptomatic women with implantation failure has been reported to be as high as 50%. The high prevalence of intrauterine pathologies in infertile women makes evaluation of the uterine cavity for fibroids, polyps, adhesions, and Mullerian abnormalities a reasonable decision. Therefore, one of the common investigations proposed for women undergoing IVF treatment is to evaluate the uterine cavity via hysteroscopy. Hysteroscopy is the gold standard test for assessing the uterine cavity It is generally performed as a definitive diagnostic tool to evaluate abnormal findings on hysterosalpingogram or saline hysterosonography performed during the course of investigation of subfertile women. Hysteroscopy not only provides accurate visual assessment of the uterine cavity, but also provides a chance to treat any pathology detected during the examination. The availability of hysteroscopes with a smaller diameter has made the use of outpatient or office hysteroscopy feasible as a routine examination. Currently, there is evidence that performing hysteroscopy before starting IVF treatment could increase the chance of pregnancy in the subsequent IVF cycle in women who had one or more failed IVF cycles. In the current study we aimed to evaluate role of Vaginal three dimensional ultrasound, chromohysteroscopy for endometrial evaluation in cases of previous failed intracytoplasmic sperm injection and histopathological examination of the suspected areas. This study was conducted on 50 cases with mean age of studied cases was 29.1 years and mean BMI was 24.38. In the current study we found that mean duration of infertility was 3.53 years and common cause was ovulatory problem in 36% of cases, male factor in 30% of cases, tubal factor in 24% of cases, endometriosis in 36% of cases and unexplained infertility in 4%. In the current study we found that mean days of menstrual cycle were 6.38, mean number of failed cycles were 1.52 and mean number of embryos transferred were 2.02. In the current study we found that mean AMH level was 2.89, mean FSH was 7.5, mean LH level was 5.8, mean TSH was 3.73 and mean PRL was 15.12. In the current study we found that 84% showed easy hysteroscopic entry but in 16% had difficult entry. In the current study we found that ultrasound had normal findings in 48% cases, and most common abnormality founded was Cs scar niche in 18% of cases followed by, arcuate uterus in 10% of cases, arcuate uterus + T shaped cavity in 8 %, cervical echogenic mass q polyp, endometrial polyp, polypoidal endometrium in 4% of cases, cervical polyp, false endometrial polyp in 2%. |