# Hysteroscopy in the Evaluation of Intrauterine Pathologies With Primary and Secondary Infertility: A Prospective Study From North India

## TL;DR

This study evaluates the effectiveness of hysteroscopy in diagnosing uterine issues in infertile women in North India.

## Contribution

The study provides new insights into the diagnostic accuracy of hysteroscopy compared to HSG in evaluating infertility.

## Key findings

- Hysteroscopy detected more intrauterine pathologies than HSG in both primary and secondary infertility groups.
- Endometrial anomalies were the most common findings on hysteroscopy, with endometritis being the most frequent histopathological diagnosis.
- Hysteroscopy showed high sensitivity and accuracy in detecting lesions requiring histopathological confirmation.

## Abstract

Introduction

Infertility remains a significant obstacle in reproductive health, affecting countless couples worldwide. Hysteroscopy is essential in the evaluation of infertile females. Therefore, this study has been conducted to evaluate the role of hysteroscopy in the evaluation of intrauterine pathologies in Indian women with primary and secondary infertility.

Methods

This was a prospective observational study conducted at a tertiary care hospital for 18 months. Ninety infertile females aged 18-40 years with normal husband semen parameters underwent infertility workups and were divided into primary and secondary infertility. All patients underwent both hysterosalpingography (HSG) and hysteroscopy. The findings were recorded, and the suspicious lesions were sent for histopathological examination.

Results

There was a statistically significant difference in mean age, mean duration of infertility, and BMI between primary and secondary infertile females. HSG showed abnormalities in 12 (19.7%) patients in primary and 8 (27.6%) patients in secondary infertility. However, 21 (34.4%) females in the primary and 10 (34.5%) in the secondary infertility group had pathologies on hysteroscopy. HSG was 54.8% sensitive and 94.9% specific with a positive predictive value (PPV) and negative predictive value (NPV) of 85% and 80%, respectively. The accuracy of HSG was 81.1%. The endometrial anomalies were the most common finding, 21 (23.2%), on hysteroscopy, and endometritis was the most common, 6 (6.6%), on histopathology (HPE). With respect to HPE, hysteroscopy had 100% sensitivity, 66.7% specificity, with 81.8% PPV, NPV as 100%, and an accuracy of 88.2% in this study.

Conclusion

Hysteroscopy is a useful procedure in diagnosing uterine pathologies that often remain undetected with USG and HSG. However, hysteroscopy alone cannot rule out tubal blockage. Hence, in female infertility, a complementary use of HSG and hysteroscopy is recommended.