Minimally invasive interventions in diagnosis and treatment of intrauterine pathology in women with infertility
The objective. To enhance the efficacy of diagnosis and treatment of various kinds of intrauterine pathology in women with infertility using minimally invasive hospital-substitute methods. Patients and methods. We made a complex examination and treatment of 226 female patients with infertility and various intrauterine pathologies aged 22 to 45 years. Minimally invasive interventions were performed using an office hysteroscope, without cervical fixation or dilation of the cervical canal, and in some cases without anaesthesia, which permitted to reduce traumatization of patients during highly informative diagnostic screening and surgical treatment of the diagnosed intrauterine pathology. Results. According to the findings of office hysteroscopy, all patients were divided into 3 groups: group 1 included 110 (49%) women with endometrial polyps, group 2 - 30 (13%) women with polyps of the cervical canal, group 3 - 86 (38%) women with intrauterine synechiae. All women were treated in outpatient settings, laser destruction of intrauterine synechiae and polypectomy of the cervical canal and uterine cavity were performed. 22 (10%) patients with complete or almost complete obliteration of the uterine cavity by fibrinous adhesions and 12 (5%) women with multiple small endometrial polyps were hospitalised. 148 (65%) patients 3-6 months after intervention underwent control office hysteroscopy. No pathology was found in 129 of them, in 5 patients single adhesions were found after complete obliteration, in 2 - endocervical polyps and in 12 -endometrial polyps. Pregnancy occurred in 51 (22%) patients from group 1, in 19 (9%) and 34 (15%) from groups 2 and 3, including pregnancies after assisted reproductive technologies. Conclusion. Office hysteroscopy as a hospital-substitute method of examination and treatment of female patients with infertility conditioned by intauterine pathology has demonstrated its high efficacy.