Routine vaginoscopic office hysteroscopy in modern infertility work-up: a randomized controlled trial

Abstract

This study aims to estimate the safety, efficacy, and patient acceptability of adding vaginoscopic office hysteroscopy (VOH) to the routine infertility diagnostic work-up for evaluation of the endometrial cavity. This study is a prospective comparative diagnostic trial. This study was conducted in a tertiary care referral facility and university hospital. This study comprised a total of 156 infertile patients scheduled for laparoscopy. Seventy-eight patients had VOH on one stop bases in addition to the usual infertility work-up and were assigned as group B while a similar number was examined by the usual diagnostic work-up and assigned as group A. The main outcome measure is the diagnostic accuracy of VOH alone in comparison to hysterosalpingography (HSG) and diagnostic laparoscopy (DL) and assessment of combined VOH and HSG in diagnosing intrauterine abnormalities. There was insignificant difference between both groups regarding socio-demographic and HSG data. Abnormal DL findings were more significant in group A. VOH detected 50 % abnormal endometrial cavity in group B with a significant superiority over HSG. There was a high percentage of agreement in the diagnosis of uterine abnormalities between HSG and VOH (96 %). Generally, VOH was an acceptable procedure with mild pain and feasible in most cases. Adding VOH to the routine diagnostic work-up of infertile couples prior to laparoscopy seems to be a feasible, safe, simple, tolerable, and quick outpatient procedure. It can diagnose intrauterine abnormalities in about a quarter of infertile women with normal HSG. VOH has an additional value to HSG and DL in diagnosing uterine. Nevertheless, whether its use would increase pregnancy rate among infertile women requires a further longitudinal comparative study.

Hysteroscopic evaluation of endometrial changes and fallopian tubal functions in women using progestin-only contraceptives

“…For the past decade, our institution has been interested in study of the FT function utilizing hysteroscopy. [11][12][13]16 The unique advantage of using OH to assess FT in POCs users was addressed in this study. This confirmed the postulated effect of POCs on the FT by statistically significant negative peristalsis and negative bubble flow tests in the proximal part of the FT, which are mostly attributed to the direct effect of progestins on the FT.…”

“…9 Office hysteroscopy (OH) has long been used to examine the uterine cavity in many gynecological conditions such as AUB, 10 unexplained infertility, and recurrent pregnancy loss. 11,12 In recent years, we have extensively studied the proximal part of the FT using a bubble flow test and physiological peristalsis via OH. 12 In addition, the combination of the bubble flow test and peristalsis (Darwishscope test) proved to be better than either test alone for assessing the function of the proximal part of the FT. 13 This study aimed to assess whether OH can be used to evaluate the mechanisms of action of POCs, diagnose possible local causes of AUB, and support in developing a treatment plan for patients experiencing symptoms who use POCs compared to those who do not use hormones.…”

Diagnostic Office Vaginohysteroscopy in Evaluation of Infertility Prior to IVF: A Retrospective Analysis of 1000 Cases

“…Diagnostic office vaginohysteroscopy has an additional value to HSG and diagnostic laparoscopy in diagnosing uterine abnormalities and even tubal patency. Diagnostic indices including accuracy of either HSG or diagnostic laparoscopy would increase if combined with office vaginohysteroscopy [2,5,9].…”