Determination of hysteroscopic, pathological and sonographic color Doppler findings of uterine in patients with a history of two or more failed Implantation in IVF/ICSI Cycles

Abstract

Fertility and pregnancy are normal parts of a couple's life, but infertility is a multifactorial problem. The purpose of this study is to investigate the hysteroscopic, pathological and color Doppler sonography findings of the uterus in patients with a history of two or more failed implantations in IVF/ICSI. Hysteroscopy is the gold standard for diagnosing pathology of the endometrium and cervical canal and can be used alone or in combination with other methods. Methods: This study was performed on 100 infertile women with primary or secondary infertility with a history of two or more failed implantations in IVF, from the beginning of January 2020 to the end of January 2021 in the infertility ward of Al-Zahra Educational in Tabriz. All patients underwent hysteroscopy and color Doppler ultrasounds of uterus. All Doppler ultrasounds of uterus and hysteroscopies were evaluated vaginally in the follicular stage to examine the endometrial cavity in patients. Results: In this study, 69% of the patients had abnormal hysteroscopic findings, which that endometrial polyps and uterine fibroids were the most common, respectively. Disordered proliferative endometrium (29.3%) and onovulatory endometrium (27.3%) Endometrial atrophy (18%) and endometrial polyps (17%) were the most common pathological abnormalities. In our investigation, the relationship between hysteroscopic pathological findings whit trans vaginal color Doppler sonographic findings in uterine according to Fisher’s exact test, There was a significant relationship between the non-homogenous myometrium report in color Doppler ultrasound with the presence of submucosal myoma and uterine polyps in hysteroscopy (P-value=0.02). According to Fisher's exact test, there was a significant correlation between the findings of trans vaginal color Doppler ultrasound and the pathological findings of the uterus, between the vascularity of the subendometrium, and the pathology report of Leiomyoma (P-value=0.002). Also, a significant difference was seen in comparing transvaginal ultrasound findings with hysteroscopy findings. The highest accordance was in the diagnosis of submucosal myoma (Kappa (%) = 100) and the lowest in the diagnosis of the uterine septum (Kappa (%) = 75.4), and no case of intrauterine adhesion was reported in transvaginal ultrasound.