Vaginal Three-Dimensional Ultrasound and Chromohysteroscopy for Endometrial Evaluation in Cases of Failed Intracytoplasmic Sperm Injection

Background: Implantation failure could be due to a variety of reasons, including embryo quality and uterine receptivity, but remains unexplained in many cases. The aim of the work was to evaluate vaginal three-dimensional ultrasound, chromohysteroscopy for endometrial evaluation in cases of previous failed intracytoplasmic sperm injection and histopathological examination of the suspected areas.

Methods: This study was carried on 50 patients who attended to the department of Gynecology in Tanta University Hospital and another private hospital. All patients was allocated in one group and examined between 30 and 120 days after the failed ICSI cycle. 3D vaginal ultrasound was done for all cases at the early luteal phase period then all the hysteroscopic operations was performed in the early follicular phase (3-4 days postmenstrual) as conventional hysteroscopy.

Results: Most common hysteroscopic finding was Polypoidal endometrium in 12% of cases, Arcuate uterus in 10% of cases, Arcuate uterus + T shaped cavity in 8% of cases and Niche, Polypectomy in 4% of cases and Biopsy of dark stained area was taken from all cases. Histopathology finding was normal Proliferative endometrium in 72% of cases and Early secretory endometrium in 4% of cases. Focal chronic nonspecific endometritis in 20% of cases and Polypoid endometrial hyperplasia in 4%.

Conclusions: Chromohystroscopy is a safe and easy procedure which can help to improve the efficacy of hysteroscopy in diagnosing cases of endometritis and to increase the success rate of IVF and ICSI. It is highly recommended to be applied to cases of repeated ICSI or IVF failure.