Revista Brasileira de Ginecologia e Obstetrícia (Aug 2010)
Avaliação histeroscópica em pacientes com infertilidade Hysteroscopic evaluation in patients with infertility
Abstract
OBJETIVO: descrever os achados da histeroscopia em pacientes com infertilidade. MÉTODOS: série retrospectiva de 953 pacientes com diagnóstico de infertilidade avaliadas por histeroscopia. As 957 pacientes em pesquisa de infertilidade foram submetidas à histeroscopia, preferencialmente na primeira fase do ciclo menstrual. Quando necessário, foram realizadas as biópsias, dirigida (sob visão direta durante o exame) ou orientada, utilizando uma cureta de Novak após definir o local a ser biopsiado durante o exame histeroscópico. Foram utilizadas porcentagens para determinação da frequência dos desfechos e teste de χ2 para correlações. O programa estatístico EpiInfo 2000 (CDC) foi utilizado para análise dos dados. RESULTADOS: cavidade uterina normal foi encontrada em 436 casos (45,8%). Esse foi o diagnóstico mais frequente em mulheres com infertilidade primária e naquelas com nenhum ou um aborto (pPURPOSE: to describe hysteroscopy findings in infertile patients. METHODS: this was a retrospective series of 953 patients with diagnosis of infertility evaluated by hysteroscopy. A total of 957 patients investigated for infertility were subjected to hysteroscopy, preferentially during the first phase of the menstrual cycle. When necessary, directed biopsies (under direct visualization during the exam) or guided biopsies were obtained using a Novak curette after defining the site to be biopsied during the hysteroscopic examination. Outcome frequencies were determined as percentages, and the χ2 test was used for the correlations. The statistical software EpiInfo 2000 (CDC) was used for data analysis. RESULTS: a normal uterine cavity was detected in 436 cases (45.8%). This was the most frequent diagnosis for women with primary infertility and for women with one or no abortion (p<0.05). Abnormal findings were obtained in 517 of 953 cases (54.2%), including intrauterine synechiae in 185 patients (19.4%), endometrial polyps in 115 (12.1%), endocervical polyps in 66 (6.0%), submucosal myomas in 47 (4.9%), endometrial hyperplasia in 39 (4.1%), adenomyosis in five (0.5%), endometritis (with histopathological confirmation) in four (0.4%), endometrial bone metaplasia in two (0.4%), and cancer of the endometrium in one case (0.1%). Morphological and functional changes of the uterus were detected in 5.6% of the cases, including uterine malformations in 32 (3.4%) and isthmus-cervical incompetence in 21 (2.2%). CONCLUSIONS: intrauterine synechiae were the most frequent abnormal findings in patients evaluated for infertility. Patients with a history of abortion and infertility should be submitted to hysteroscopy in order to rule out intrauterine synechiae as a possible cause of infertility.
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