Trang 1 Full Terms & Conditions of access and use can be found athttps://www.tandfonline.com/action/journalInformation?journalCode=ihuf20Georgi Stamenov Stamenov, Salvatore Giovanni Vita
Human Fertility an international, multidisciplinary journal dedicated to furthering research and promoting good practice ISSN: (Print) (Online) Journal homepage: www.tandfonline.com/journals/ihuf20 Hysteroscopy and female infertility: a fresh look to a busy corner Georgi Stamenov Stamenov, Salvatore Giovanni Vitale, Luigi Della Corte, George Angelos Vilos, Dimitar Angelov Parvanov, Dragomira Nikolaeva Nikolova, Rumiana Rumenova Ganeva & Sergio Haimovich To cite this article: Georgi Stamenov Stamenov, Salvatore Giovanni Vitale, Luigi Della Corte, George Angelos Vilos, Dimitar Angelov Parvanov, Dragomira Nikolaeva Nikolova, Rumiana Rumenova Ganeva & Sergio Haimovich (2022) Hysteroscopy and female infertility: a fresh look to a busy corner, Human Fertility, 25:3, 430-446, DOI: 10.1080/14647273.2020.1851399 To link to this article: https://doi.org/10.1080/14647273.2020.1851399 Published online: 02 Dec 2020 Submit your article to this journal Article views: 507 View related articles View Crossmark data Citing articles: View citing articles Full Terms & Conditions of access and use can be found at https://www.tandfonline.com/action/journalInformation?journalCode=ihuf20 HUMAN FERTILITY 2022, VOL 25, NO 3, 430–446 https://doi.org/10.1080/14647273.2020.1851399 REVIEW ARTICLE Hysteroscopy and female infertility: a fresh look to a busy corner Georgi Stamenov Stamenova , Salvatore Giovanni Vitaleb , Luigi Della Cortec , George Angelos Vilosd , Dimitar Angelov Parvanova , Dragomira Nikolaeva Nikolovae, Rumiana Rumenova Ganevaa and Sergio Haimovichf aNadezhda Women’s Health Hospital, Sofia, Bulgaria; bObstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy; cDepartment of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples "Federico II", Naples, Italy; dDepartment of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Western University, London, Canada; eDepartment of Medical Genetics, Medical Faculty, Medical University – Sofia, Sofia, Bulgaria; fHillel Yaffe Medical Center/Technion - Israel Technology Institute, Hadera, Israel ABSTRACT ARTICLE HISTORY Received 30 March 2020 Hysteroscopy has evolved from the traditional art of examining the uterine cavity for diagnostic Accepted 28 September 2020 purposes to an invaluable modality to concomitantly diagnose and (see and) treat a multitude of intrauterine pathologies, especially in the field and clinics specialising in female reproduction KEYWORDS This article reviews the literature on the most common cervical, endometrial, uterine and tubal Diagnosis; female infertility; pathologies such as chronic endometritis, endometrial polyps, adenomyosis, endometriosis, hysteroscopy; intrauterine endometrial atrophy, adhesions, endometrial hyperplasia, cancer, and uterine malformations pathologies; treatment The aim is to determine the efficiency of hysteroscopy compared with other available techni- ques as a diagnostic and treatment tool and its association with the success of in vitro fertilisa- tion procedures Although hysteroscopy requires an experienced operator for optimal results and is still an invasive procedure, it has the unique advantage of combining great diagnostic and treatment opportunities before and after ART procedures In conclusion, hysteroscopy should be recommended as a first-line procedure in all cases with female infertility, and a spe- cial effort should be made for its implementation in the development of new high-tech proce- dures for identification and treatment infertility-associated conditions Introduction diagnostic value, hysteroscopy has also been shown to treat successfully intrauterine abnormalities result- Infertility is estimated to affect 9% of all reproductive- ing in significant enhancement of fertility and repro- aged couples, and female factors are responsible for ductive outcomes (Bosteels et al., 2015) This review 20–35% of all infertility cases (Boivin et al., 2007) summarises the available evidence on the role of hys- Hysteroscopy is a valuable tool and is currently consid- teroscopy in both the diagnosis and treatment of ered the “gold standard” approach in assessing the common uterine and tubal pathologies associated uterine cavity for diagnosis and treatment of female with female fertility and adverse reproduct- infertility (Bettocchi et al., 2004) Pathologies identified ive outcomes during hysteroscopy in infertile women include chronic endometritis, endometrial polyps, submucosal Materials and methods myomas, intrauterine adhesions, adenomyosis, thin endometrium, endometrial hyperplasia and/or cancer The literature search was conducted using MEDLINE, and uterine malformations such as the uterine septum, EMBASE, Web of Sciences, Scopus, OVID, and T-shaped uterus, arcuate uterus and unicornuate ute- Cochrane Library as electronic databases Papers were rus (Practice Committee of American Society for identified with the use of a combination of the follow- Reproductive Medicine, 2012a) ing text words: “hysteroscopy,” “female infertility,” “endometritis,” “endometrial polyps,” “adenomyosis,” Many health care providers advocate that undertak- “intrauterine adhesions,” “myoma,” “endometrial can- ing diagnostic hysteroscopy before assisted reproduc- cer,” “uterine malformations,” “tubal endometriosis” tion treatment increases the chances of pregnancy and “endometrial atrophy” from 1970 to September significantly (Bosteels et al., 2010) In addition to its CONTACT Salvatore Giovanni Vitale sgvitale@unict.it Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Via Santa Sofia 78, Catania, 95123, Italy ß 2020 The British Fertility Society HUMAN FERTILITY 431 2019 A review of articles also included the abstracts the absence of hysteroscopic features does not rule of all references retrieved from the search No restric- out CE’s diagnosis (Song et al., 2019) The most appro- tions for language or geographic location were priate time for hysteroscopic identification of chronic applied The electronic search and the eligibility of endometritis is immediately after menstruation or in studies were independently assessed by two authors the mid-luteal phase of the cycle (LDC and DAP) Treatment with broad-spectrum antibiotics such as Results doxycycline, ofloxacin, and metronidazole has been proven relatively effective leading to the elimination Based on the results identified in the search, the path- of the source of infection, restoration of normal endo- ologies were grouped under the following headings metrial histology and receptivity and improvement of and subheadings IVF outcome in patients suffering from repeated implantation failure (RIF) (Vitagliano et al., 2018) The Intracavitary pathologies observed clearance rate of CD138ỵ plasma cells after antibiotics treatment was up to 96% (Kitaya et al., Chronic endometritis 2012) and a recent review by Kimura et al (2019) sug- Two studies reported that chronic endometritis is gested that the administration of oral antibiotics is a associated with female infertility, and significantly promising therapeutic option in infertile women with increased the frequency of implantation failure and RIF due to CE spontaneous abortions (Cicinelli et al., 2015; Kitaya, 2011) Therefore, chronic endometritis could be regarded as one of the potential causes of both primary and The prevalence of chronic endometritis in infertile secondary infertility, and all women with confirmed women has been reported to range between 2.8 and infertility should be investigated for chronic endomet- 39%, and it may be more than 60% in women diag- ritis and treated accordingly nosed with repeated implantation failure and recur- rent miscarriages (Kasius et al., 2011) The diagnostic Endometrial polyps gold standard for chronic endometritis is endometrial Endometrial polyps are common in infertile women sampling and histological detection of increased stro- with a prevalence of up to 45% (Fatemi et al., 2010; mal edoema accompanied by plasmacyte infiltration Makrakis et al., 2009) It is also suggested that polyps within the endometrial stroma (Crum et al., 1983) are present at a higher incidence in women with other Immunohistochemistry (IHC) for detection of the coexisting pathologies such as endometriosis (Kim plasma cell marker CD138 (also known as syndecan-1) et al., 2003) A potential mechanism by which polyps is necessary to improve the detection rate of CE (Chen may cause infertility include irregular endometrial et al., 2016; Crum et al., 1983) bleeding and inflammation, spatial inhibition of sperm transport, impaired endocrine function, uterine recep- Diagnostic hysteroscopy may also be utilised to tivity, and embryo-endometrium contact and cross- confirm the histologic findings (Cicinelli et al., 2005; talk, and inhibition of sperm binding to the zona pel- Oliveira et al., 2003; Polisseni et al., 2003) In several lucida through increased glycodelin levels (Oehninger studies, the endometrial sample collected under hys- et al., 1995; Richlin et al., 2002) teroscopy has shown higher specificity and positive and negative predictive values than other methods of The most common symptom of polyps is abnormal sample collection (Cicinelli et al., 2009; Moreno et al., uterine bleeding (Bakour et al., 2002; Elfayomy et al., 2018; Song et al., 2019) Hysteroscopically, endometrial 2012) Hysteroscopy remains the gold standard in the inflammation (endometritis) is characterised by hyper- management of endometrial polyps allowing simultan- aemia (accentuated blood vessel accumulation at the eous diagnosis and polypectomy (American periglandular level), stromal edoema (pale and thick- Association of Gynaecologic Laparoscopists, 2012) ened endometrium in the proliferative phase) as well Usually, this procedure is performed in the early prolif- as micropolyps (small pedunculated, vascularised pro- erative phase of the menstrual cycle (Figure 1) (Clark trusions of the uterine mucosa measuring