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Evaluation of cavity before ART: Saline Infusion Sonohysterography

Evaluation of cavity before ART: Saline Infusion Sonohysterography. IVF and IMPLANTATION. Implantion rates are still low after IVF (%10- 25 (a) ). İmplantation failure is related to inadequate endometrial receptivity ( 2/3) embryo (1/3) (b) Increase in endometrial receptivity leads to

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Evaluation of cavity before ART: Saline Infusion Sonohysterography

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  1. Evaluation of cavity before ART: Saline Infusion Sonohysterography

  2. IVF and IMPLANTATION • Implantion rates are still low after IVF (%10- • 25(a)). İmplantation failure is related to • inadequate endometrial receptivity (2/3) • embryo (1/3) (b) • Increase in endometrial receptivity leads to • İncrease in pregnancy rates • Decrease in early pregnancy losses • Decrease in multipl pregnancies • (a) de los Santos et al., 2003 • (b) Simon et al., 1998;Ledee-Bataille et al., 2002

  3. When implantation fails to occur despite the transfer of chromosomally normal good quality embryos, other factors that may impede implantation must be affecting implantation: • Endometritis, • endocrine abnormalities, • thrombophilias, • immunologic factors • congenital and acquired anatomic factors

  4. Methods to evaluate uterine cavity • Hysterosalphingography (HSG) • Transvaginal ultrasonography (TVU) • Saline infusion sonohysterography (SIS) • Office hysteroscopy (OHS) • Diagnostic hysteroscopy

  5. Possible uterine factors associated with implantation failure in IVF • Uterine submucous fibroids • Endometrial polyps • İntrauterine adhesions • Congenital uterine anomalies

  6. Saline Infusion Sonohysterography • Use of SIS in general infertile population • Use of SIS to evaluate cavity before ART

  7. Use of SIS in general infertile population

  8. Use of SIS in general infertile population

  9. Use of SIS in general infertile population Histeroskopinin avantajı aynı anda tedavi imkanı

  10. Ultrasound Obstet Gynecol 2004; 24: 566–571Which infertile women should be indicated forsonohysterography? ANDO H et al

  11. Which infertile women should be indicated forsonohysterography? Conclusions TV-SCSH should be performed on selected patients following assessment of endometrial images on transvaginal sonography in order to diagnose intra- and pericavitary lesions in infertile women

  12. Saline Infusion Sonohysterography • Use of SIS in general infertile population • Use of SIS to evaluate cavity before ART

  13. Use of SIS to evaluate cavity before ART

  14. Uterine cavity assessment prior to IVF • No statistically significant difference was observed in the pregnancy outcome for patients undergoing IVF who had sonohysterography compared with that for patients undergoing IVF during the same period who previously had a uterine evaluation by a different method. • Conclusion(s): Sonohysterography offers advantages over in-office hysteroscopy and hysterosalpingography for evaluation of the uterus before IVF. Kim et al. Fertil Steril 1998

  15. Uterine cavity assessment prior to IVF Conclusions: SCHS in comparison with H/S: 87.5 sensitivity, 100% specificity, 100% PPV, 91.6 NPV. TVUS in comparison with H/S: 81 sensitivity, 95% specificity, 93% PPV, 86 NPV. However; unlike SCHS, TVUS (1) could not could not diagnose submucosal fibroids in the presence of multiple fibroid uterus (2) distinguish between a hyperplastic endometrium and a large polyp; or (3) differentiate between an arcuate and a septate uterus Ayida G et al. Ultrasound Obstet Gynecol 1997

  16. Uterine cavity assessment prior to IVF • SIS was performed in 80 patients before ICSI and compared with 240 cycles in patients with normal HSG • A subsequent hysteroscopy was undertaken in patients with intracavitary lesions • Clinical pregnancy rates were comparable between groups (40.2% vs 42.5%) • SIS appears to be a simple, inexpensive and safe alternative to HSG for the evaluation of uterine cavity before IVF/ICSI Alatas et al Hum Reprod 1998

  17. Role of saline infusion sonography in uterineevaluation before frozen embryo transfer cycleGera et al Fertil& Steril 2008 group A: positive SIS findings and treated group B: positive SIS findings and not treated group C : negative SIS findings

  18. In an IVF program, SHG as an outpatient diagnostic method is easy, sensitive, and well tolerated.

  19. Conclusions: • compared with hysteroscopy, SHG seems to offer similar diagnostic capabilities in at least some studies in assessing uterine cavity. It is also less invasive and costly. • In comparison with HSG, SHG has been found superior for evaluation of the uterus. It has a higher sensitivity, better tolerated, does not require the use of radiation, and provides better diagnostic accuracy. • larger, prospective, randomized studies has to be designed to draw a definite conclusion regarding the efficiency of SHG before ART

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