宫腔镜诊治输卵管近端梗阻53例

目的探讨宫腔镜对输卵管近端阻塞的诊断和治疗作用。方法53例输卵管近端阻塞的继发不孕症患者,行宫腔镜检查及治疗。结果宫腔镜发现宫腔内异常病理变化46例,主要异常病理变化为：宫腔内膜性粘连25例（54.3%）,子宫内膜息肉12例（26%）,子宫内膜增生6例（13%）,纤维性粘连3例（6.5%）;宫腔镜治疗后输卵管通畅46例,再通成功率为86.7%;术后1年宫内妊娠41例（77.4%）。结论宫腔内因素是造成输卵管近端阻塞的主要原因之一,宫腔镜检查、治疗是诊治输卵管性近端梗阻性不孕的一种微创有效的治疗技术。     

超声监测联合宫腔镜诊断不孕患者子宫内膜异常的价值

目的探讨阴道超声和宫腔镜检查对不孕患者子宫内膜病变的诊断价值。方法对在我中心不孕门诊进行阴道超声、宫腔镜检查的152例患者分为两组进行对照分析。自然周期超声监测内膜回声异常的105例为研究组,超声监测内膜正常的47例为对照组。结果研究组宫腔镜检查确诊内膜病变为84例（80.00%）,对照组为4例（8.51%）,两组比较差异有非常显著性意义（P〈0.001）。研究组中,子宫内膜息肉占30.48%（32/105）,内膜增殖36.19%（38/105）,粘膜下肌瘤0.95%（1/105）,输卵管阻塞8.57%（9/105）,内膜炎症3.81%（4/105）;对照组异常内膜为内膜粘连4.25%（2/47）,内膜炎症4.25%（2/47）。以宫腔镜结果为金标准,经阴道超声监测对子宫内膜病变诊断的敏感度95.45%（84/88）,特异度67.19%（43/64）。研究组确诊内膜异常者84例,妊娠率46.43%（39/84）,对照组确诊为内膜正常者43例,妊娠率74.41%（32/43）,两组比较差异有显著意义（P〈0.05）。结论阴道超声是诊断不孕症患者宫腔内病变的一种简便、廉价、无创伤、诊断率高的方法,可以作为不孕患者宫腔镜检查的初筛,而宫腔镜检查则为内膜病变提供准确的诊断。     

宫腔镜诊治继发不孕110例分析

目的探讨宫腔镜对继发不孕患者宫腔内病变的诊断和治疗作用。方法110例继发不孕症患者,行宫腔镜检查及治疗。结果110例中宫腔异常情况为80例（72.7%）,宫腔镜下异常病理情况分别为：宫腔粘连42例,其中轻度粘连24例,中度粘连14例,重度粘连4例;子宫内膜息肉19例;子宫内膜增生17例;粘膜下肌瘤2例。术后1年内妊娠72例（65.5%）,术后2年内妊娠12例。结论宫腔内因素是造成继发不孕的主要原因之一,宫腔镜检查、治疗是诊治继发不孕的一种微创有效的治疗技术。     

822例不孕症宫腔镜诊治的临床意义

目的探讨宫腔镜手术在不孕症患者诊治中的应用价值。方法回顾性分析应用宫腔镜诊治不孕症822例的临床资料。结果 822例不孕症患者行宫腔镜检查,宫腔及输卵管近端异常检出率为83.5%(686/822)。其中:宫腔大致正常者136例(16.6%);子宫内膜病变45l例(54.9%);宫腔粘连125例(15.2%);输卵管近端阻塞69例(8.4%);子宫畸形34例(4.1%);子宫粘膜下肌瘤5例(0.6%);宫内异物2例(0.2%)。822例不孕患者经宫腔镜治疗后随访,有204例正常宫内妊娠,术后妊娠率为24.8%(204/822)。其中:宫腔大致正常者25/136(18.4%,);子宫内膜病变103/451(22.8%,);宫腔粘连39/125(31.2%,);输卵管近端阻塞20/69(29%,);子宫畸形15/34(44.1%,);子宫粘膜下肌瘤2/5(40.0%,);宫内异物0/2(0%,)。结论宫腔镜诊治不孕症准确、有效、简单、微创、并发症少,是目前诊治女性不孕症最有效的手段之一,值得临床应用、推广。     

子宫输卵管碘造影与超声子宫水造影诊断女性不孕症的临床研究

目的评价子宫输卵管碘造影（HSG）与超声子宫水造影（SIS）对于女性不孕症子宫腔病变诊断价值。方法96例女性不孕症患者，同时行HSG与SIS，以宫腔镜（HS）和病理结果（Pathol）为标准，计算两种方法诊断子宫内膜息肉、黏膜下肌瘤、宫腔粘连及子宫腔畸形的敏感性、特异性、Youden指数和Kappa值。结果37例患者被诊断患有子宫腔病变。HsG诊断内膜息肉、黏膜下肌瘤、宫腔粘连的敏感性、特异性、Youden指数和Kappa分别为0．78、0．97、0．67、0．79；0．92、0．99、0．83、0．91；0．88、0．98、0．62、0．81。SIS的各参数分别为0．83、0．99、0．79、0．86；1．00、0．99、0．92、0．95；0．50、0．99、0．38、0．59。HSG和SIS诊断子宫腔畸形的各参数均为1．00。结论与传统的HSG相比，SIS对女性不孕子宫腔病变的诊断有很高的敏感性和特异性，而且简便易行、疼痛轻微、并发症少。     

pAKt在不明原因性不孕症妇女着床期子宫内膜的表达及意义

目的研究磷酸化AKt（pAKt）在不明原因性不孕症妇女着床期子宫内膜的表达变化及意义。方法收集18份原发性不孕症、不明原因性不孕症妇女黄体中期子宫内膜组织作为研究对象，并收集30份继发性不孕症、双侧输卵管阻塞患者黄体中期子宫内膜组织作为对照。用SP免疫组化法确定两组患者子宫内膜pAKt与白血病抑制因子（UV）的组织学定位及半定量表达。结果LIF在两组患者子宫内膜的表达均主要定位在腔上皮和腺上皮胞浆，pAKt在两组患者子宫内膜的表达主要位于间质细胞且呈胞浆强表达。两组患者子宫内膜LIF与pAKt蛋白表达半定量分析（sP免疫组化法）：不明原因性不孕症患者子宫内膜LIF与pAKt表达量较双侧输卵管阻塞患者明显降低（P〈0．05），两组患者中IVF／ICSI后未妊娠者子宫内膜LIF与pAKt表达量较妊娠者明显降低（P〈0．01）。结论子宫内膜容受性降低是不明原因性不孕症患者不孕原因之一，着床期子宫内膜pAKt表达降低可能是不孕症患者子宫内膜容受性降低的原因之一。     

RT-3D-HyCoSy对子宫发育异常不孕症患者输卵管通畅性的评估价值

目的 探讨经阴道实时三维子宫输卵管超声造影（RT-3D-HyCoSy）在不同类型子宫发育异常不孕症中的诊断效果及对患者输卵管通畅性及受孕情况的评估价值。方法 选择不孕症患者145例，年龄21～36岁，平均年龄29.21岁；原发性不孕85例，继发性不孕60例。均接受RT-3D-HyCoSy检查、X射线子宫输卵管碘油造影，以腹腔镜检查为金标准。评估RT-3D-HyCoSy检查子宫畸形类型，以及输卵管通畅性的诊断符合率，观察治疗后的受孕情况。结果 145例患者中，纵隔子宫52例（35.86%），单角子宫48例（33.10%），双子宫24例（16.55%），弓形子宫12例（8.28%）。RT-3DHyCoSy、X射线子宫输卵管碘油造影诊断输卵管通畅性异常的灵敏度分别为90.91%、77.27%，特异度分别为93.24%、84.46%，准确度分别为92.14%、81.07%。超声引导输卵管造影诊断输卵管阻塞（88.46%vs 73.08%）、输卵管通而不畅（92.50%vs 80.00%）、输卵管通畅（93.24%vs 84.46%）符合率均高于X射线子宫输卵管碘油造影诊断符合率（P <0...     

宫腔镜检查对子宫异常出血的诊断价值

目的探讨宫腔镜检查对异常子宫出血的诊断价值。方法回顾分析2005年6月至2006年6月就诊于我院的非阴道及宫颈因素所致异常子宫出血患者148例,行宫腔镜检查并取活检进行病理诊断。结果宫腔镜检查发现宫颈管息肉25例,子宫内膜息肉47例,粘膜下肌瘤7例,胚物残留4例,子宫内膜炎4例,疑似子宫内膜癌6例,子宫畸形2例,宫腔粘连5例,阳性率67.5%。病理诊断子宫内膜单纯增生70例,单纯伴复杂增生2例,局灶非典型增生3例,子宫内膜癌2例,子宫内膜息肉32例,子宫内膜炎5例,蜕膜样变4例,内膜息肉样增生1例,病理结果异常发生率为80.4%。结论宫腔镜检查异常子宫出血,同时病理诊断对宫内病变的诊断及治疗具有非常重要的价值,值得推广应用。     

腹腔镜与宫腔镜联合治疗不孕不育症18例临床观察

目的通过宫腔镜、腹腔镜检查,探讨引起不孕症的原因,以及在女性不孕症诊治中的应用。方法对18例不孕妇女进行宫腔镜和腹腔镜检查,并予以相应治疗。结果术后6个月内妊娠6例,占33%;术后1年内妊娠（含6个月内）妊娠8例,占44%。结论宫腔、腹腔炎症与不孕症有关,宫腔粘连、输卵管阻塞等仍为不孕症的主要原因,宫腔镜和腹腔镜的联合应用对不孕症患者的诊治效果非常理想。     

阴道超声与宫腔镜在诊断围绝经期子宫异常出血中的应用

目的探讨阴道超声和宫腔镜检查诊断围绝经期子宫异常出血的临床应用价值。方法收集患者180例,以病理检查结果作为＂金标准＂,比较阴道超声和宫腔镜检查的灵敏度及阳性预测的价值。结果在子宫内膜过度增生、子宫内膜癌、未见明显占位性病变（正常子宫内膜、子宫内膜炎、萎缩性子宫内膜）的诊断中,阴道超声检查的灵敏度分别为77.3%、57.1%、82.2%,宫腔镜检查的灵敏度分别为97.7%、92.9%、95.6%,两组之间的差异有统计学意义（P〈0.05）。在子宫内膜息肉、子宫内膜过度增生的诊断中,阴道超声检查的阳性预测价值为79.7%和75.6%,宫腔镜检查的阳性预测价值为96.2%和93.5%,两组之间的差异有统计学意义（P〈0.05）。结论阴道超声可以作为围绝经期妇女临床筛检的常规方法 ,宫腔镜检查可以作为在阴道超声发现宫腔异常情况或不能明确时进一步检查的重要手段。     

Endometrial morphological and immunohistochemical features in females with primary and secondary infertility

Endometrial scrapes and biopsy specimens from 47 females with primary and secondary infertility were studied by histological and immnohistological (estrogen and progesterone receptors, Ki67) methods. Endometrial abnormalities, such as luteal phase defect, hyperplasia, endometrial polyps, and chronic endometritis, were detected in all the patients. There were considerable changes in the expression of estrogen and progesterone receptors and impaired endometrial proliferative processes. There was no clear correlation of immunohistochemical parameters with blood hormone levels in both primary and secondary infertility. The findings may be of significance in choosing the schemes of assisted procreation technologies.     

Histopathological study of endometrium in infertility

A study of 200 cases of primary and secondary infertility was carried out in the department of pathology, Dr. V.M. Medical College, Solapur. Endometrial specimens were evaluated in the light of menstrual history to find out the incidence of various endometrial changes in cases of infertility. All cases underwent endometrial biopsy premenstrually. Haematoxylin and eosin staining was done for dating of endometrium and diagnosis of corpus luteal defect and anovalutory cycles. PAS stain was done in 50 cases of infertility with control of 25 cases to detect the amount of glycogen. Menstrual problems were seen in 38.2% of patients. Anovulatory infertility was present in 28.2% cases. Luteal phase defect was seen in 20% cases. Cystoglandular hyperplasia was seen in 1.7% cases & tuberculous endometritis was present in 2.6% cases. Glycogen deficiency was seen in 30% cases of luteal phase defect.     

The prevalence of abnormal cervical cytology in women with infertility

The aim of this study was to compare the frequency of abnormal cervical cytology in women with infertility problems with that of fertile women by using ThinPrep® liquid‐based Pap Tests™. A retrospective case–control study for over 2 years was conducted. The cases included all women with infertility problems who had Pap tests during their infertility treatment period. The cases were further subdivided into primary and secondary infertility groups. The control group included all women without infertility problems who had routine Pap tests in the same period. The age and demographic features were adjusted and matched for both groups. Statistical analysis included chi‐square test and Fischer exact test. The infertility group (n = 490) showed significantly (P < 0.05) more abnormal cervical squamous epithelial abnormalities (48 positive cases, 9.8%) than the controls (n = 7,150, 216 positive cases, 3%). Women with secondary infertility had more epithelial abnormalities and more high‐grade lesions than women with primary infertility. Women with infertility had statistically significant higher frequency of squamous intraepithelial lesions than women without infertility problems of similar age and demographic background. The data suggest that women with infertility might benefit from more frequent cervical cytology screening. Diagn. Cytopathol. 2010;38:791–794. © 2009 Wiley‐Liss, Inc.     

The comparative evaluation of uterine and cervical mucosa cytology with endometrial histopathology in cows

Reproductive tract abnormalities especially in the uterus and ovaries of cows often results in infertility. The object of this study was to determine the relationship between the cytology of uterine and cervical mucosa and endometrial histopathology in normal and endometritic cows. In this study, the genital tracts of 131 slaughtered cows were collected. According to macroscopic appearances and histopathological evaluation, reproductive tracts were divided into normal and abnormal. Cytological samples were obtained from the discharges of cervical mucosa and uterine fluid that were collected by wet cotton swab and gentle aspiration. Differential cellular counts were carried on Giemsa stained smears of the mucosa. Comparison of cell densities of normal cows with endometritic cows showed significant differences (P<0.05) in the macrophage presence both by swab (0.00±0.00) and aspiration (0.16±0.55) methods. Comparison of cell densities in different grades of endometritis showed a significant difference (P<0.05) in the neutrophil percentage in cervical mucosa between the swabbing and aspiration methods. In this study, there were no significant differences in cell densities between the two collection methods in cows affected with either acute or chronic endometritis. However, there was significant difference in the neutrophil density in aspirated cervical mucosa compared to the swab collection in cows affected with subacute endometritis. Cytological methods can be useful for the diagnosis of clinical and subclinical endometritis of cows.     

Endometrial micropolyps at fluid hysteroscopy suggest the existence of chronic endometritis

BACKGROUND: At fluid hysteroscopy the presence of endometrial micropolyps (less than 1 mm of size) is a frequent finding. Although their origin is still unknown, in our experience they are associated with stromal edema, endometrial thickening and periglandular hyperhaemia that suggest the existence of chronic endometritis. This study will aim to describe these lesions and evaluate their inflammatory significance by comparing hysteroscopic and histological findings. METHODS: 820 women underwent hysteroscopy and endometrial biopsy. Sensitivity, specificity, positive and negative predictive values and accuracy of the micropolyps presence for the diagnosis of chronic endometritis were calculated. RESULTS: Micropolyps were found in 96 cases (11.7% of all hysteroscopies); in 90 (93.7%) of these cases histology confirmed the presence of chronic endometritis. In women without micropolyps, chronic endometritis was significantly less frequent (78 cases, 10.8%) (P < 0.000001). The likelihood of chronic endometritis for women with micropolyps was very high (odds ratio 124.2, confidence interval 50.3-205.4). The sensitivity, specificity, positive and negative predictive values were 54%, 99%, 94% and 89%, respectively; the diagnostic accuracy was 90%. CONCLUSIONS: The presence of endometrial micropolyps at fluid hysteroscopy is significantly associated with endometrial inflammation and can be considered a reliable diagnostic sign for this pathology.     

Endometritis

Endometritis is nowadays rare in developed countries and typically shows a subclinical or mild course; therefore, there are probably more cases of endometritis than diagnosed but they lack clinical relevance. In the fertile period of life it can be the reason for vaginal bleeding and infertility. The most common causes for non-specific endometritis are residual placental tissue after abortion or childbirth, intrauterine interventions, lesions within the uterine cavity, such as endometrial polyps, endometrial hyperplasia and neoplasms, intrauterine devices (IUD) and cervical stenosis. The histological detection of plasma cells in the endometrial stroma is required for the diagnosis of chronic endometritis. These can be detected immunohistochemically using anti-CD138 antibodies, which should be carried out particularly in cases of infertility with only slight inflammatory symptoms and few plasma cells. The use of an IUD containing progestin is frequently associated with an asymptomatic lymphoplasmacytic infiltration. After curettage or endometrial biopsy, an eosinophilic xanthogranulomatous or granulomatous endometritis and also a foreign body granuloma reaction can occur. Specific forms of endometritis, such as caused by tuberculosis, sarcoidosis, mycoplasma and herpes are very rare. Cytomegalovirus endometritis is associated with immunosuppression. Endometritis caused by infections with Chlamydia trachomatis is characterized by an extensive lymphoplasmacytic infiltration. The differential diagnoses of chronic endometritis include the very rare malignant lymphoma, which is usually characterized by a relatively monotonous cell infiltration.     

Karman's cannula and vacuum aspirator in gynecological practice.

The charts of 340 patients who underwent an endometrial suction procedure using Karman''s cannula and syringe were reviewed. The therapeutic uses of this instrument were for the treatment of chronic endometritis (18.6%), the evacuation of incomplete or missed abortion (14.6%) and hydatidiform mole (0.8%), and the retrieval of the missing tail of an intrauterine contraceptive device (1.2%). Its diagnostic indications include: the investigation of infertility (55.3%), dysfunctional uterine bleeding (8.7%), and postcoital bleeding (0.8%). The diagnostic yield of the instrument was 96.6%. Transient postoperative abdominal pain occurred in 65.9% of the cases while cervical dilatation preceded aspiration in 12.9% of the cases with cervical stenosis. The advantages of the instrument are discussed and its usefulness in everyday gynecological practice highlighted.     

The relationship between endometriosis and semen analysis: a review of 490 consecutive laparoscopies

Laparoscopy was carried out on 490 infertile women whose partners had semen analyses showing a minimum of 5 X 10(6) motile spermatozoa/ml. Patients were divided into two groups using WHO criteria: those in whom the semen parameters were normal and those in whom there was any abnormality. The overall incidence of endometriosis was the same in both groups. Among women with primary infertility, mild endometriosis was significantly more common in the abnormal semen group. Thus among couples in whom there is an explanation for continuing sub-fertility, mild endometriosis is more common. This finding calls into question the causal relationship between endometriosis and primary infertility and suggests that in susceptible women, infertility may predispose towards the occurrence of endometriosis.     

Limitations of the criteria used to diagnose histologic endometritis in epidemiologic pelvic inflammatory disease research

While endometrial neutrophils and plasma cells are criteria used to diagnose histologic endometritis in epidemiologic pelvic inflammatory disease (PID) research, plasma cell misidentification and nonspecificity may limit the accuracy of these criteria. Herein, we examined: (1) the identification of endometrial plasma cells with conventional methyl green pyronin-based methodology versus plasma cell-specific (CD138) immunostaining, (2) the prevalence of endometrial plasma cells among women at low risk for PID, and (3) endometrial leukocyte subpopulations among women diagnosed with acute or chronic histologic endometritis by conventional criteria. We observed an absence of CD138⁺ cells in 25% of endometrial biopsies in which plasma cells had been identified by conventional methodology, while additional immunohistochemical analyses revealed indistinguishable inflammatory infiltrates among women diagnosed with acute or chronic endometritis by conventional criteria. Among women considered at lower risk for PID development, flow cytometric analyses detected plasma cells in 30% of endometrial biopsy specimens, suggesting that these cells, even when accurately identified, only nonspecifically identify upper genital tract inflammatory processes. Combined, our findings underscore the limitations of the criteria used to diagnose histologic endometritis in PID-related research and suggest that satisfactory understanding of PID pathogenesis, treatment, and prevention is hindered by continued use of these criteria.     

Is chromosome analysis mandatory in the initial investigation of normovulatory women seeking infertility treatment?

BACKGROUND: There is no agreement about the frequency of chromosomal abnormalities (CAs) in the female partner of an infertile couple and therefore there is no evidence base for determining whether karyotype analysis is mandatory before the initiation of infertility treatment. The aim of this prospective study was to estimate the prevalence of karyotype abnormalities in normovulatory women attending an infertility clinic and compare it to that known to be present in the newborn female population. METHODS: Cytogenetic testing was performed in 1206 women with normal ovulatory cycle seeking infertility treatment. At least 15 GTG-banded metaphases were analysed in each case. In the case of a structural abnormality, fluorescent in situ hybridization (FISH) analysis and high resolution banding (HRB) were performed on a new blood sample to elucidate the aberration. When mosaicism was suspected, the number of analysed metaphases was increased to a total of 115 and an additional analysis of 200 metaphases was done on a second blood sample. RESULTS: A chromosomal abnormality was demonstrated in 0.58% (95% CI: 0.28-1.19) of cases which did not differ significantly from that reported in female newborns (0.79%; 95% CI: 0.68-0.94). Balanced reciprocal translocation was observed in 0.4% of patients (n = 5), paracentric inversion of chromosome X in 0.08% (n = 1) and gonosomal mosaicism in 0.08% (n = 1). However, chromosomal aberrations were less common among females with primary infertility compared to those with secondary infertility (0.25 versus 1.25%, P = 0.04). CONCLUSIONS: The present study suggests that routine cytogenetic analysis cannot be advocated in normovulatory infertile women. Nevertheless, the relatively higher frequency of abnormal karyotypes in women with secondary infertility indicates that this subgroup of patients might benefit from a routine karyotype analysis.