Transvaginal sonohysterography and hysteroscopy in the evaluation of female infertility, habitual abortion or metrorrhagia. A comparative study.

BACKGROUND: To assess the diagnostic value of sonohysterography in the evaluation of metrorrhagia and infertility with hysteroscopy as the standard. METHODS: Sixty-six women, 41 with metrorrhagia, 20 with infertility and five with habitual abortion, were examined by sonohysterography and hysteroscopy. Sterile saline instilled through a baby-feeding tube was used to distend the uterine cavity during sonohysterography. Hysteroscopy was performed with a 4 mm hysteroscope under general anesthesia. The endometrial polyps and submucous myomas were recorded and the findings subsequently compared. RESULTS: Of the 66 women, 60 were successfully examined by both sonohysterography and hysteroscopy. The overall sensitivity and specificity for sonohysterography was 90.9% and 100%, respectively. The positive and negative predictive values were 100% and 90%, respectively. When examining the metrorrhagia and infertility groups separately the sensitivity and specificity and predictive values were found to be 88.5%, 100%, 100% and 76.9% (metrorrhagia) and 100% for all parameters in cases of infertility. No complications were recorded during the procedures. CONCLUSION: Sonohysterography is a simple, fast, well tolerated and accurate method to evaluate the uterine cavity in patients with metrorrhagia or infertility.

Pre- and postoperative therapy with GnRH agonist for endometrial resection. A prospective, randomized study.

BACKGROUND: To assess the value of endometrial preparation, with preoperative and pre- and postoperative GnRH agonist therapy in transcervical endometrial resection. METHODS: Sixty women with menorrhagia were randomly divided between three groups: A: no preoperative preparation, B: goserelin 3.6 mg given as a subcutaneous implant 4-6 weeks preoperatively, and C: the same regimen as B, and repeated on the day of endometrial resection. At follow-up visits 1, 3, 6 and 12 months after operations the patients were interviewed for duration, amount and pains of menstrual periods. RESULTS: The duration of surgery for the pretreated group (32.8 +/- 5.1 min) and the group treated postoperatively (30.9 +/- 8.9 min) were significantly shorter than that in the control group (46.4 +/- 11.5 min) (p < 0.01). The weight of endomyometrial strips was about 3 times lower for group B and C as compared to group A (p < 0.01). Three months following the procedure twenty five percent of patients in group A were amenorrheic or showed scanty bleeding as compared to 58% and 85% in group B and C (p < 0.05 and p < 0.01), respectively. At 12 months follow-up these rates were 35%, 58% and 67% respectively (A versus B: NS, A versus C: p < 0.05) and 24%, 65% and 75% after excluding larger submucosal fibroids (A versus B: p < 0.025, A versus C: p < 0.005). No statistical difference was demonstrated between group B and C. Sixty-nine percent of pretreated patients (group B + C) versus 35% of women in group A reported improved or relieved menstrual cramps (p < 0.05). CONCLUSIONS: GnRH pretreatment facilitates endometrial resection and increases the rate of amenorrhea and scanty bleeding postoperatively. Whether supplementary postoperative therapy with GnRH agonist enhances the success rate further is uncertain.