Spiegelung der Gebärmutterhöhle
Die Gebärmutterspiegelung ist ein endoskopisches Verfahren, bei dem ein optisches Instrument durch den Gebärmutterhals in die Gebärmutterhöhle eingeführt wird. Diese Technik dient dazu, die Gebärmutterhöhle auf Auffälligkeiten wie Polypen, Myome, Zwischenwände, Verwachsungen etc. zu untersuchen. Bei diesem Verfahren sind keine Einschnitte notwendig. Je nachdem wird diese Technik mit oder ohne Betäubung durchgeführt. Trotz unauffälliger Ultraschalluntersuchung finden sich in ca 4% der Fälle bisher unbekannte Befunde mit Relevanz für die Fruchtbarkeit.
Zur Frage Hysteroskopiescreening oder nicht
Empfehlung: 3mm mini – HSK
Hysteroscopy methods evaluated in infertile patients
Issue 11: 25 May 2007
Source: European Journal of Obstetrics & Gynecology and Reproductive Biology 2007;in press
They randomized a total of 950 female candidates for IVF to outpatient hysteroscopy with use of either a 3.5mm diameter mini-hysteroscope (602 women) or a traditional 5-mm diameter hysteroscope (348 women). All hysteroscopies were performed between days 6 and 11 of the menstrual cycle, and no analgesic drug or anesthesia was administered.
At the end of the procedure, each patient completed a questionnaire including a visual analogue scale to evaluate the pain experienced during the procedure.
Similarities and differences
There were no significant differences between the two groups in terms of age, body mass index, parity, and years of infertility. Uterine cavity findings were also similar in each group: 60-64 percent of the women had a normal cavity, 23-24 percent had endometrial polyps, 4-5 percent had fibroids, and 4-5 percent had a uterine septum.
In addition, the failure rate was significantly lower in the mini-hysteroscopy group, at 3 percent, than in the traditional hysteroscopy group, at 6.3 percent. In most cases in both groups, failure was due to the presence of a cervical stenosis or unexpected bleeding, and was not due to the type of hysteroscope used, the researchers say
Discussing their findings, the researchers write that “mini-hysteroscopy is a very effective diagnostic tool in an infertility work-up” and is more widely accepted than traditional hysteroscopy. They suggest that mini-hysteroscopy could be appropriate for routine use in infertility evaluation. They say: “We routinely perform an outpatient hysteroscopy in all patients undergoing infertility investigation in our unit, in order to assess uterine cavity receptivity and endometrial competence.
“By so doing, in a one-stop approach, uterine pathology that could impair fertility is removed. When mini-hysteroscopy is employed, the distress experienced by patients is minimal and recovery time is immediate.”