Qual o papel da histeroscopia de rotina previamente ao primeiro tratamento de procriação medicamente assistida?

• Autor(a) principal: Afonso,Hermínia Gomes
• Data de Publicação: 2016
• Outros Autores: Dantas,Sofia, Miguelote,Rui, Reis,Isabel
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302016000400002
• topic: Hysteroscopy; Infertility; Uterine disease; Ultrasonography; Assisted reproductive techniques

Overview: Integrity of the uterine cavity is critical to embryonic implantation and it is mandatory to evaluation it in the routine investigation of infertility. Hysteroscopy is considered the gold standard, allowing concomitant treatment , which optimizes the conditions for future embryo transfers. Nevertheless, controversies still exist in its routine performance prior to the first assisted reproductive technique. Aims: To assess the concordance between the findings of transvaginal ultrasonography and hysteroscopy and to investigate risk factors for intracavitary pathology. Study Design: Retrospective observational study. Population: 104 women submitted to transvaginal ultrasonographic evaluation (with normal uterine cavity evaluation) and hysteroscopy before the first assisted reproductive technique. Methods: A database was constructed through the analysis of each patient's file. Descriptive and inferential statistical analysis was performed with Statistical Package for Social Sciences, version 20.0. P ≤0,05 was considered statistically significant. Results: The study group had a mean age of 33,3 years and a mean duration of infertility of 45,6 months. About 87% patients had primary infertility. Hysteroscopy revealed intracavitary alterations in 20 women. In 6 patients a simultaneous surgical procedure was performed and 4 had an alteration of the therapeutic plan. No complications were documented. Descriptive analysis revealed that uterine abnormalities observed in hysteroscopy were significantly more frequent in women aged ≥ 35years (35,1 vs 32,8%, p=0,008). In the logistic regression it was observed that hysteroscopic alterations were significantly and positively associated with female age ≥35years (OR=2,85; IC95%: 1,1-7,7). Conclusions: Ultrasound findings were not consistent with hysteroscopic findings in 19,23% patients, and this was more frequent in women aged ≥35years. Hysteroscopy has a special role in the investigation of infertility, mainly in populations with risk factors for intracavitary anomaly and its impact should be reassessed.