Sonohysteroscopy (SHS): A New Diagnostic
Tool To Identify Uterine Causes Of Implantation Failure.
SA Brody1,2, K Hill1, C Mejia1 A Bispham1,
GP Warden1. 1 Advanced Fertility Institute,
San Diego, CA. and 2Division of Endocrinology
and Metabolism, UCSD School of Medicine, La Jolla, CA.
Objectives:
The most efficacious method to evaluate the uterine cavity
prior to IVF and embryo transfer (IVF-ET) remains to be
established. Hysterosalpyngography (HSG), hysterosonography
(HSO) and hysteroscopy(H) all have some limitations in evaluating
the uterine cavity. Sonohysteroscopy (SHS) is a new office-based
procedure designed to provide a comprehensive evaluation
of the uterine cavity.
Design:
Prospective cohort study.
Materials and Methods:
Beginning in January 2001 SHS was offered to all patients
prior to undergoing IVF-ET. SHS was performed during the
follicular phase of the cycle. A 3.1 mm flexible hysteroscope
(Olympus) was inserted through the external cervical os
after betadine lavage. Doxycycline was administered orally.
Normal saline was used as the fluid medium. A measurement
was obtained upon reaching the apex of the uterine cavity.
After removal of the hysteroscope, a 5.0 MHz transvaginal
ultrasound probe was inserted into the vagina. The instilled
fluid was visualized using an ATL ULTRAMARK 4PLUS scanner.
All findings were documented by still pictures.
Results:
SHS was performed on an initial group of 25 patients. They
ranged in age from 29 to 51. A prior HSG was performed in
19 cases. The average time to complete SHS was 13 minutes.
On average, 55 mL of normal saline was used. The patients'
subjective rating of pain and discomfort averaged 2.4 (on
a scale of 1 to 10). Two patients required post-procedural
analgesia. No patients required cervical dilatation, cervical
blocks or clamps. Satisfactory studies were performed in
100% of patients. SHS changed the anatomic diagnosis in
8 of the 19 patients (42%) with abnormal findings. Overall,
diagnostic abnormalities were found in 17 of the patients
studied (68%). The breakdown of abnormal pathology was as
follows: 4, polyps; 4, myomas; 1, septae; 2, IUA; 2, cervical
stenosis; 2, occluded ostia; and 2, adnexal pathology.
Conclusion:
SHS provides a comprehensive diagnostic evaluation of the
uterine cavity, the endometrial architecture and all pelvic
viscera. Since it is a quick, in-office procedure, with
high patient acceptance, it may prove to be the definitive
method for evaluating pelvic anatomy prior to ART.
