Zum Stellenwert der Hysteroskopie als Screeningmethode in der Sterilitätsdiagnostik

Zusammenfassung

Die Implantation bzw. ihr Ausbleiben werden multifaktoriell beeinflusst. Ein gesicherter anatomischer Einflussfaktor ist das Cavum uteri. Seit langem wird von einigen Autoren vor der Durchführung von Maßnahmen der assistierten Reproduktion eine Basishysteroskopie gefordert. In der Praxis hat sich dieses Konzept jedoch bisher nicht umfassend durchgesetzt.

Die ambulante Minihysteroskopie ermöglicht eine schnelle und direkte Betrachtung des Cavum uteri ohne Anästhesie und wird von den Patientinnen gut toleriert. Pro und Contra der ambulanten Minihysteroskopie im Rahmen der Sterilitätsdiagnostik werden anhand der aktuellen Literatur und eigener Daten diskutiert. Die Vaginalsonographie kann in der Diagnostik intrakavitärer Pathologien die Hysteroskopie nicht ersetzen.

Wir empfehlen die Durchführung einer Minihysteroskopie vor jeder Sterilitätstherapie, um potenziell negative Einflüsse einer intrauterinen Pathologie auf die Implantation oder die Abortrate auszuschließen. Dieses Konzept muss in weiteren Studien kritisch überprüft werden.

Abstract

Implantation or implantation failure are influenced by different factors. One of the well known anatomic factors involved is the uterine cavity. Outpatient mini-hysteroscopy allows fast and direct evaluation of the uterine cavity without anaesthesia. It has long been recommended but has not always been accepted that a basic hysteroscopy should be performed in patients before carrying out assisted reproductive techniques. Transvaginal sonography should be performed at the same time but can not replace hysteroscopy. Available literature and own results are discussed.

In summary, we recommend outpatient mini-hysteroscopy as a screening method before starting assisted reproductive techniques to exclude intrauterine pathologies. This concept needs to be evaluated in further studies.

Schlüsselwörter

Basisdiagnostik - Hysteroskopie - Minihysteroskopie - Sterilität

Key words

Basic diagnostics - hysteroscopy - mini-hysteroscopy - sterility

Literatur

• 1 Shushan A, Rojansky N. Should hysteroscopy be a part of the basic infertility workup?.  Hum Reprod. 1999;  14 1923-1924
• 2 Pabuccu R, Atay V, Urman B, Ergun A, Orhon E. Hysteroscopic treatment of septate uterus.  Gynaecol Endosc. 1995;  4 213-215
• 3 Grimbizis G F, Camus M, Tarlatzis B, Bontis J N, Devroey P. Clinical implications of uterine malformations and hysteroscopic treatment results.  Hum Reprod Update. 2001;  7 161-174
• 4 Nawroth F, Schmidt T, Freise C, Foth D, Mallmann P, Römer Th. Uterus septus with primary infertility - an operating indication?.  Zentralbl Gynäkol. 2001;  123 644-647
• 5 Nawroth F, Schmidt T, Freise C, Foth D, Römer T. Is it possible to recommend an „optimal“ postoperative management after hysteroscopic metroplasty? A retrospective study with 52 patients showing a septate uterus.  Acta Obstet Gynecol Scand. 2002;  81 55-57
• 6 Nawroth F, Foth D, Schmidt T, Römer T. Results of a prospective comparative study of transvaginal hydrolaparoscopy and chromolaparoscopy in the diagnostics of infertility.  Gynecol Obstet Invest. 2001;  52 184-188
• 7 Marcoux S, Maheux R, Berube S. Laparoscopic surgery in infertile women with minimal or mild endometriosis. Canadian Collaborative Group on Endometriosis.  N Engl J Med. 1997;  337 217-222
• 8 Parazzini F. Ablation of lesions or no treatment in minimal-mild endometriosis in infertile women: a randomized trial.  Hum Reprod. 1999;  14 1332-1334
• 9 Tanahatoe S J, Hompes P GA, Lambalk C B. Should diagnostic laparoscopy be performed in the infertility work up programme in patients undergoing intrauterine insemination?.  Hum Reprod. 2003;  18 8-11
• 10 Römer T, Straube (Hrsg) W. Diagnostic Hysteroscopy. Berlin, New York; de Gruyter 1996: 12-45
• 11 Ashton D, Amin H K, Richart R M, Neuwirth R S. The incidence of asymptomatic uterine anomalies in women undergoing transcervical sterilization.  Obstet Gynecol. 1988;  72 28-30
• 12 Simon C, Martinez L, Pardo F, Tortajada M, Pellicer A. Mullerian defects in women with normal reproductive outcome.  Fertil Steril. 1991;  56 1192-1193
• 13 Homer H A, Li T C, Cooke I D. The septate uterus: a review of management and reproductive outcome.  Fertil Steril. 2000;  73 1-14
• 14 Farhi J, Ashkenazi J, Feldberg D, Dicker D, Orvieto R, Ben-Rafael Z. Effect of uterine leiomyomata on the results of in-vitro fertilization treatment.  Hum Reprod. 1995;  10 2576-2578
• 15 Bajekal N, Li T C. Fibroids, infertility and pregnancy wastage.  Hum Reprod Update. 2000;  6 614-620
• 16 Römer T. Intrauterine Adhäsionen. Römer T, Mallmann P, Straube W Pschyrembel Wörterbuch - Therapie in Gynäkologie und Geburtshilfe. Berlin, New York; de Gruyter 2001: 6-7
• 17 Al-Inani H. Intrauterine adhesions.  Acta Obstet Gynecol Scand. 2001;  80 986-993
• 18 March C M. Intrauterine adhesions.  Obstet Gynecol Clin North Am. 1995;  22 491-505
• 19 Schenker J G, Margalioth E J. Intrauterine adhesions: an update appraisal.  Fertil Steril. 1982;  37 593-610
• 20 Nawroth F, Foth D, Schmidt T. Mini-hysteroscopy as an essential part of routine basic diagnostics in patients with primary infertility.  J Am Assoc Gynecol Laparosc. 2003;  10 396-398
• 21 Römer Th. Post-abortion hysteroscopy - a method of early diagnosis of congenital and acquired intrauterine causes of abortions.  Eur J Obstet Gynecol Reprod Biol. 1994;  57 171-173
• 22 Dicker D, Ashkenazi J, Dekel A, Orvieto R, Feldberg D, Yeshaya A, Ben-Rafael Z. The value of hysteroscopic evaluation in patients with preclinical in-vitro fertilization abortions.  Hum Reprod. 1996;  11 730-731
• 23 Demirol A, Gurgan T. The effect of the treatment of intrauterine pathologies with hysteroscopy in the patients with recurrent IVF failure.  Reprod Biomed Online. 2004;  8 590-594
• 24 Nawroth F, Foth D, Schmidt T. Hysteroscopy only after recurrent IVF failure?.  Reprod Biomed Online. 2004;  8 726
• 25 Zikopoulos K A, Kolibianakis E M, Platteau P, de Munck L, Tournaye H, Devroey P, Camus M. Live delivery rates in subfertile women with Asherman's syndrome after hysteroscopic adhesiolysis using the resectoscope or the Versapoint system.  Reprod Biomed Online. 2004;  8 720-725
• 26 Shalev J, Meizner I, Bar-Hava I, Dicker D, Mashiach R, Ben-Rafael Z. Predictive value of transvaginal sonography performed before routine diagnostic hysteroscopy for evaluation of infertility.  Fertil Steril. 2000;  73 412-417
• 27 Kupesic S, Kurjak A, Skenderovic S, Bjelos D. Screening for uterine abnormalities by three-dimensional ultrasound improves perinatal outcome.  J Perinat Med. 2002;  30 9-17
• 28 Hartman A, Hartman J, Hartman M, Streiner D L, Tur-Kapsa I. Sonohysterography vs. 3D ultrasound for the diagnosis of uterine anomalies: a prospective blinded study of 500 consecutive women.  Hum Reprod. 2004;  19 (Suppl 1) i42
• 29 Alatas C, Urman B, Aksoy S. Evaluation for uterine cavity by sonohysterography in women scheduled for intracytoplasmic sperm injection.  Hum Reprod. 1998;  13 (Suppl 1) 2461-2462
• 30 Gronlund L, Hertz J, Helm P, Colov N P. Transvaginal sonohysterography and hysteroscopy in the evaluation of female infertility, habitual abortion or metrorrhagia. A comparative study.  Acta Obstet Gynecol Scand. 1999;  78 415-418
• 31 Lindheim S R, Morales A J. Comparison of sonohysterography and hysteroscopy: lessons learned and avoiding pittfalls.  J Am Assoc Gynecol Laparosc. 2002;  9 223-231
• 32 Barbot J. Hysteroscopy and hysterography.  Obstet Gynecol Clin North Am. 1995;  22 591-603
• 33 Golan A, Eilat E, Ron-El R, Herman A, Soffer Y, Bukovsky I. Hysteroscopy is superior to hysterosalpingography in infertility investigation.  Acta Obstet Gynecol Scand. 1996;  75 654-656
• 34 Cicinelli E, Matteo M, Causio F, Schonauer L M, Pinto V, Galantino P. Tolerability of the mini-pan-endoscopic approach (transvaginal hydrolaparoscopy and minihysteroscopy) versus hysterosalpingography in an outpatient infertility investigation.  Fertil Steril. 2001;  76 1048-1051
• 35 Wang C W, Lee C L, Lai Y M, Tsai C C, Chang M Y, Soong Y K. Comparison of hysterosalpingography and hysteroscopy in female infertility.  J Am Assoc Gynecol Laparosc. 1996;  3 581-584
• 36 Brown S E, Coddington C C, Schnorr J, Toner J B, Gibbons W, Oehninger S. Evaluation of outpatient hysteroscopy, saline infusion hysterosonography, and hysterosalpingography in infertile women: a prospective, randomized study.  Fertil Steril. 2000;  74 1029-1034
• 37 Leydendecker G, Kunz G, Wildt L, Beil D, Deininger H. Uterine hyperperistalsis and dysperistalsis as dysfunctions of the mechanism of rapid sperm transport in patients with endometriosis and infertility.  Hum Reprod. 1996;  11 1542-1551
• 38 Kissler S, Siebzehnrübl E, Kaufmann M. Stellenwert der Hysterosalpingoszintigraphie in der Sterilitätsdiagnostik.  Geburtsh Frauenheilk. 2003;  63 682-684
• 39 De Iaco P, Marabini A, Stefanetti M, Del Vecchio C, Bovicelli L. Acceptability and pain of outpatient hysteroscopy.  J Am Assoc Gynecol Laparosc. 2000;  7 71-75
• 40 Wong A Y, Wong K, Tang L C. Stepwise pain score analysis of the effect of local lignocaine on outpatient hysteroscopy: a randomized, double-blind, placebo-controlled trial.  Fertil Steril. 2000;  73 1234-1237
• 41 Yang J, Vollenhoven B. Pain control in outpatient hysteroscopy.  Obstet Gynecol Surv. 2002;  57 693-702
• 42 Cravello L, Porcu G, D'Ercole C, Roger V, Blanc B. Identification and treatment of endometritis.  Contracept Fertil Sex. 1997;  25 585-586