Efficiency of hysteroscopy in the diagnosis of chronic endometritis

Abstract

Purpose - to determine the diagnostic value of a hysteroscopic examination of the uterine cavity to assess the state of the endometrium in women with a history of unsuccessful ART attempts against the background of chronic endometritis.

Materials and methods. A prospective study was conducted in women with a history of chronic endometritis, on the basis of the Medical Center LLC «ISIDA-IVF», for the period 2019-2021. It was enrolled 110 women of reproductive age with chronic endometritis and repeated untreated ART (55 women with barrier training - group I; 55 women without barrier training - group II). To achieve the set goals, taking into account the clinical and anamnestic data of women in the studied groups, at the stage of pregnancy planning, we resorted to endoscopic examination of the uterine cavity and endometrium on days 7-11 of the menstrual cycle. Endoscopic examination of the uterine cavity was performed using a rigid hysteroscope manufactured by Karl Storz (Germany). The threshold value of static reliability was taken as p<0.05.

Results. In groups I and II, hysteroscopy was performed in almost every 2 patients - 28 (50.9%) and 27 (49.1%), respectively. The hysteroscopic sign of chronic endometritis was the uneven thickness of the endometrium, which was in 21 (75.0%) patients of group I and in 20 (74.1%) of group II (p>0.05). Evaluation of the color of the mucosa showed a sign of inflammation - hyperemia of the mucosa, which occurred in every second patient of group I - 16 (57.1%) and group II - 15 (55.5%), respectively (p>0.05). according to the combination of hysteroscopic signs, the diagnosis of chronic endometritis was justified in 24 (85.7%) patients of group I and in 23 (85.1%) patients of group II, a normal hysteroscopic picture was noted in 4 (14.3%) and 4 (14.9%) of women, respectively. When visualizing the uterine cavity, various hysteroscopic signs of chronic endometritis were revealed, the combination of which made it possible to identify variants of macrotypes: hyperplastic, hypoplastic, without signs of hyper- and hypoplasia. In group I, hyperplastic macrotype of chronic endometritis occurred in 11 (39.3%) patients versus 7 (25.9%) among patients of group II (p<0.05). Hypoplastic macrotype of chronic endometritis in the studied groups was observed in 6 (21.4%) patients and 5 (18.5%), respectively (p>0.05). chronic endometritis without signs of hyper- and hypoplasia was 11 (39.2%) among patients of group I and 15 (44.4%) in group II (p<0.05).

Conclusions. An analysis of the diagnostic significance of hysteroscopy showed that, based on the totality of hysteroscopic signs, the diagnosis of chronic endometritis was correct in 85.7% and 85.1% of patients. with a history of unsuccessful ART attempts against the background of chronic endometritis. In these patients, the hyperplastic macrotype of chronic endometritis prevailed - 39.3%. It was found that hysteroscopy in the differential diagnosis of macrotypes of chronic endometritis has low specificity (33.3%), but high sensitivity (91.1%) and diagnostic accuracy (89.4%). The diagnostic value of the hysteroscopy method turned out to be higher in the hyperplastic macrotype of chronic endometritis, which in turn contributed not only to the visualization of the pathological process, but also to the rational removal of altered tissue areas.

The study was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was adopted by the Local Moral Committee of the institution indicated in the work. Informed consent was obtained from the women for the study.

No conflict of interests was declared by the author.