Treatment of infertility associated with endometriosis by selective tubal catheterization under hysteroscopy and laparoscopy.

OBJECTIVE: To evaluate the efficacy of treatment for infertility associated with endometriosis by selective tubal catheterization under hysteroscopy and laparoscopy. STUDY DESIGN: Eighty-eight infertile women who underwent selective tubal catheterization with insufflation of oil-soluble radiopaque dye were reviewed. The efficacy of treatment was analyzed with regard to conception rate. RESULTS: The conception rate after selective tubal catheterization was higher in women with endometriosis (60%) than in women without endometriosis (36.5%) (p < 0.05). Most women conceived within the first 4 months after treatment. No statistical difference in conception rate was observed among patients with stage I, II, or III disease. CONCLUSIONS: Selective tubal catheterization with insufflation of oil-soluble radiopaque dye was an effective treatment for infertility associated with endometriosis.

Hysteroscopic assessment of midsecretory-phase endometrium, with special reference to the luteal-phase defect.

To investigate the functional aspects of secretory-phase endometrium, hysteroscopy was performed in 61 patients for in vitro fertilization-embryo transfer (IVF-ET), and 50 women for infertility evaluation. All women had normal ovulatory cycles. The hysteroscopic assessment of secretory-phase endometrium was made by characterizing the glandular openings (GO) and vasculature. The assessments were classified as 'good': characterized by ring-type GO and well-developed vessels; and 'poor': characterized by dot and/or punctate-type GO and fine vasculature. In the 30 patients classified 'good' prior to the IVF cycle, there was a higher pregnancy rate (40%) than in 'poor' ones (13%). Thirty of 50 infertile women were classified 'good', and their average age was lower than that of the remaining 20 in the 'poor' group. Preovulatory estradiol was significantly higher in the 'good' than in the 'poor' group. From an analysis of 20 patients with a 'poor' assessment, it was demonstrated that the maturation of secretory-phase endometrium was affected by a failure of folliculogenesis, progesterone secretion, endometrial growth and menstrual shedding.

Relationship between endometrial histology, morphometry and ultrasound texture in the follicular phase of infertile women with natural menstrual cycles.

The relationship between endometrial histology and ultrasonographic texture in the follicular phase was investigated. The endometrial sonographic texture of 32 infertile women with normal menstrual cycles was classified into three patterns (L, H and I) and histological and morphometrical analyses were performed. Endometrial specimens from pattern L, which showed multi-layered endometrium characterized by three hyperechogenic lines with inner hypo-echogenic regions, had smaller, similar-sized endometrial glands and few stromal cells. Those from pattern H which showed entirely homogeneous hyperechogenic endometrium, had larger, various-sized glands and more stromal cells. Those from pattern I which showed heterogeneous hyperechogenic and partially hypo-echogenic endometrium, had the largest, most variable-sized glands and many stromal cells. The differences in sonographic texture may be related to the histological and morphometrical findings.