1. Role of Hysteroscopy in Diagnosis and Treatment of Infertility Factors M.E.Parsanezhad M.D Professor and chair Department of Gynecology & Obstetrics Head : Reproductive Medicine & Infertility Division E.Mail: parsame@rogers.com Shiraz University of Medical Sciences Tehran UMS, Congress 2014. Tehran IRAN

2. OBJECTIVE To determine whether routine hysteroscopy as a part of infertility evaluation…., and before ART, even in women without pathologic TVS or HSG findings, should be recommended.

3. INTRODUCTIION Uterine factors represent only 2% to 3% of causes of infertility; however, abnormal intrauterine findings are present in approximately 25% of infertile women.

4. Hysteroscopy & Infertility Uterine factors that benefit most from hysteroscopic evaluation are structural abnormalities that distort uterine cavity symmetry or obstruct the tubal passages:

5. Hysteroscopy & Infertility submucous leiomyomas, intrauterine adhesions, uterine anomalies, and tubal cornual occlusions.

6. Hysteroscopy & Infertility The mentioned lesions can interfere with spontaneous fertility and can compromise pregnancy rates in ART cycles.

7. Hysteroscopy & Infertility Hysteroscpy Before ART?

8. Hysteroscopy & Infertility More than 2/3 of infertile couples undergoing ART failed to conceive. Factors leading to failure of conception.. 1-Suboptimal ovarian stimulation 2- Poor embryo quality, 3-Impaired uterine receptivity.

9. Hysteroscopy & Infertility The incidence of uterine abnormalities including endometritis, submucosal myomas, endometrial polyps, intrauterine adhesions, and congenital Mullerian anomaly in patients undergoing ovarian stimulation for ART has been reported to vary from 21 to 56 %

10. Hysteroscopy & Infertility Therefore, diagnosis and treatment of intrauterine disease becomes necessary before performance of assisted reproductive techniques (ART)

11. Hysteroscopy & Infertility In general, hysterosalpingography (HSG), transvaginal sonography (TVS), sonohysterography, or hysteroscopy are performed to detect such lesions as well as other disease of the female genital system.

12. Hysteroscopy & Infertility The advantage of hysteroscopy is that it offers the opportunity not only of diagnosis but also therapy in the same session, under direct view.

13. Hysteroscopy & Infertility Currently, hysteroscopy is recommended only when an abnormal intrauterine finding is detected via TVS or HSG to confirm the diagnosis and remove the lesion. In addition, hysteroscopy follows in most cases after repeated ART failures.

14. Hysteroscopy & Infertility In as much as some research studies have reported a substantial increase in the pregnancy rate in infertile women after ART when intrauterine abnormalities have been previously detected and treated during hysteroscopy.

15. Hysteroscopy & Infertility while other clinical trials did not show an increase in implantation and live birth rate.

17. 2014 a retrospective study

18. 2014 a RCT

21. 2014 A PROSPECTIVE COHORT STUDY

22. 2014 A Prospective study

23. 2014 a RCT

24. Hysteroscopy & Infertility CONCLUSION; As an invasive procedure, hysteroscopy is recommended before ART cycles and for confirmation and treatment of doubtful endometrial disease but not as a routine infertility evaluation.