ABSTRACT
Background: Implantation failure after intracytoplasmic sperm injection [ICSI] is related to either maternal factors or embryonic causes. The maternal factors include uterine anatomic abnormalities either congenital or acquired. Three-dimensional transvaginal ultrasound allows detailed evaluation of pelvic organs. Office hysteroscopy is the gold standard tool for visualization of intracavitary lesions and the cervical canal in an office-based environment
Aim of The Work: It was to compare between three-dimensional ultrasound [3D USS] and hysteroscopy for evaluation of the intrauterine cavity after trial of ICSI and to study the accuracy of diagnostic test in a tertiary care facility
Patients and Methods: It was a prospective; blinded; controlled clinical trial comparative study. Both hysteroscopy and 3D USS procedures were done for uterine cavity assessment after failed attempt of ICSI treatment for fifty two asymptomatic infertile women
Results: Seventeen cases of our studied patients were without intracavitary or cervical lesions. From all studied cases, lesions [n=66] were seen either by hysteroscopy or by 3D USS where lesions [n=24] were seen by hysteroscopy and seen by ultrasound. Lesions [n=34] were seen by hysteroscopy. Lesions [n=36] were seen by ultrasound. Measure of agreement of Kappa was 0.273. Overall sensitivity of 3D USS was 70.59% and specificity 62.50% with positive predictive value [PPV] 66.67% and negative predictive value [NPV] 66.67%, accuracy was 66.67%, positive likehood ratio [LR+ve] 1.88% and negative likehood [LR-ve] 0.47%. The pvalue was 0.026, which is statistically significant
Conclusion: It is important to investigate the uterine cavity in infertile women with history of unsuccessful ICSI. 3D USS has a good sensitivity and specificity for diagnosis of uterine cavity abnormalities and it could be used before hysteroscopy as a first line of investigation of intrauterine lesions
ABSTRACT
Abstract: The vaginal flora contains a large variety of bacterial species, including aerobic and anaerobic organisms, as revealed by modern microbiologic methods. Intra uterine contraceptive device [IUCD] is one of the most popular contraceptive methods used world wide. Use of an IUCD might change the flora of the vagina in favor of the growth of bacteria associated with bacterial vaginosis [BV]. The aim of this study was to detect the changes in the normal vaginal flora and possible association of BV with copper T380A IUCD insertion. This study was a longitudinal study that included 30 women who accepted IUCDs copper T380A as a method of a birth control. All women were scheduled for another visit one month after IUCD insertion. They were interviewed and vaginal swabs were collected before and after IUCD insertion and cultured for aerobic and anaerobic bacteria. Direct smear stained with Gram stain was evaluated using Ison and Hay scoring system. Our study revealed that there was no statistically significant relationship between alteration of vaginal flora and IUCD insertion
Conclusion: IUCD is apparently a safe and cost effective method of contraception if proper selection of candidate and proper practices of insertion was done