Publication: IVF öncesi diagnostik histeroskopi: Hangi kadınlara yapılması uygundur?
Abstract
Amaç: IVF öncesi histeroskopi, IVF başarısızlığı olan kadınlara iyi bir bilimsel kanıt olmadan önerilmektedir. Amacımız bu endikasyonun bilimsel kanıtı yanında uterin patolojileri tahmin etmede belirleyici diğer muhtemel etkenleri araştırmaktır. Materyal ve Metot: Yüz yetmiş altı ardışık IVF siklusu öncesi, endometrial patolojileri taramak için yaptığımız ofis histeroskopi uygulamalarının sonuçlarını bu retrospektif çalışmada inceledik. Endometrial patoloji saptanan olgular ile saptanmayan olgular yaş, infertilite süresi, tipi ve sebebi, küretaj anamnezi, önceki embryo transfer (ET) başarısızlıklarının sayısı açısından karşılaştırıldılar. Lojistik regresyon analizi ile endometrial patolojiyi belirleyebilecek bağımsız değişkenler araştırıldı. Sonuçlar: Yüzde 16 olguda kavitede patoloji saptandı: %39’unda endometrial polip, %32’sinde endometrial adhezyon, %18’inde uterin septum ve %11’inde leiomyom mevcut idi. Regresyon analizinde sadece önceki ET başarısızlık sayısının uterin patolojiyi bağımsız olarak tahmin edebildiği gözlendi. En az bir ET başarısızlığı olanlarda patoloji olma riski olmayanlara göre 2.7 kat artmış idi. En az iki ve üç başarısızlığı olanlarda ise olasılık oranları sırasıyla 3.2 ve 4.7 idi. Olasılık oranlarında, artan ET başarısızlığı ile bir artma eğilimi vardı. Tartışma: IVF öncesi kavite patolojilerinin ofis histeroskopi ile taranması için ET başarısızlığı olan kadınlar en uygun adaylardır. Başarısızlık sayısı arttıkça kavitede lezyon çıkma olasılığı da artmaktadır.
Objective: Empirically, hysteroscopy before IVF has been suggested to be performed in women with repeated IVF failures. We aimed to analyse the basis for this indication, and also, to determine other possible predictors for a uterine pathology before an IVF cycle. Materials and Methods: One-hundred-seventy-six consecutively seen women, who were screened for an intrauterine pathology before the IVF cycle by using office hysteroscopy, were analysed in this retrospective analysis. Women with an endometrial pathology were compared to those without any pathology with respect to their clinical characteristics, such as age, duration of infertility, type of infertility, history of previous curettage, cause of infertility and number of previous embryo transfers. Logistic regression analysis was used for the statistical analysis. Results: In 16% of subjects, a pathology was observed; 39% of these women had endometrial polyps, 32% had endometrial adhesions, 18% had uterine septum and 11% had leiomyomas. Regression analysis revealed that the number of previous IVF-ET failures was the only predictor for a uterine pathology. Women with at least one IVF-ET failure were 2.7 times more likely to have an endometrial pathology than those, who had no failures. Odds ratios were 3.2 for women with two or more failures, and 4.7 for those with three or more failures. There was an increasing trend in odds ratios with increasing number of IVF failures. Conclusion: Women with any previous number of IVF failures are good candidates for screening for endometrial pathology before IVF. Increasing number of failures increases the risk for detecting a lesion in the cavity.
Objective: Empirically, hysteroscopy before IVF has been suggested to be performed in women with repeated IVF failures. We aimed to analyse the basis for this indication, and also, to determine other possible predictors for a uterine pathology before an IVF cycle. Materials and Methods: One-hundred-seventy-six consecutively seen women, who were screened for an intrauterine pathology before the IVF cycle by using office hysteroscopy, were analysed in this retrospective analysis. Women with an endometrial pathology were compared to those without any pathology with respect to their clinical characteristics, such as age, duration of infertility, type of infertility, history of previous curettage, cause of infertility and number of previous embryo transfers. Logistic regression analysis was used for the statistical analysis. Results: In 16% of subjects, a pathology was observed; 39% of these women had endometrial polyps, 32% had endometrial adhesions, 18% had uterine septum and 11% had leiomyomas. Regression analysis revealed that the number of previous IVF-ET failures was the only predictor for a uterine pathology. Women with at least one IVF-ET failure were 2.7 times more likely to have an endometrial pathology than those, who had no failures. Odds ratios were 3.2 for women with two or more failures, and 4.7 for those with three or more failures. There was an increasing trend in odds ratios with increasing number of IVF failures. Conclusion: Women with any previous number of IVF failures are good candidates for screening for endometrial pathology before IVF. Increasing number of failures increases the risk for detecting a lesion in the cavity.