1. HYSTEROSCOPY FOR INFERTILE PATIENT An Evidence Based Approach Dr.Mohamed El Sherbiny MD Obstetrics&Gynecology Senior Consultant Damietta General Hospital Damietta Egypt

3. DIAGNOSTIC HYSTEROSCOPY

7. SHOULD HYSTERSCOPY BE DONE ROUTINLY IN THE EVALUATION OF INFERTILITY ? NO

12. SHOULD HYSTEROSCOPY BE USED ROUTINELY AT THE TIME OF LAPAROSCOPY FOR . THE INVESTIGATION OF . INFERTILIY ?

13. El Sherbiny M, Medical J of Cairo Univ., Vol.65 No. 3, Sept. 1997 El Sherbiny M, The 7th Annual Meeting Of The Intern. Society for Gynecologic Endoscopy ,Sun City, South Africa;15:18 March,1998 Hysteroscopy done at laparoscopy time, has low complication rate, high degree of safety, minimal time requirement and adds little equipment & cost. Positive hysteroscopic findings were found in many cases (15%) despite having normal HSG and no suggestive history of uterine lesion

14. Unexplained infertility Small endometrial polyp Small cervical polyp Adhesion at cornual cones Cornual polyp Endometrial dystrophies (atrophy or hyperplasia) that may affect receptivity or implantation especially in ART.

15. ` Unexplained infertility Cornual polyp cervical polyp HSG is free

17. OPERATIVE HYSTEROSCOPY

23. 36 38 Uterine Polyp Sonohysterography Hysteroscopy

24. Electro- resection of myoma by loop electrode loop electrode loop electrode Fibroid Resected tissue

28. Intrauterine synechiae

29. HSG : Filling defect Stellate & irregular, Commonly inhomogeneous HYSTEROSCOPY Confirmation Evaluation of the extent of the disease Intrauterine Synechiae

30. The American Fertility Society classification of intrauterine adhesions.1988. Extent of < 1/3 1/3 - 2/3 >2/3 Cavity Involved 1 2 4 Type of Filmy filmy & Dense Dense Adhesions 1 2 4 Menstrual Normal Hypomenorrhea Amenorrhea Pattern 0 2 4 Stage I (Mild) 1 - 4 Stage II (Moderate 5 - 8 Stage III (Severe) 9 - 12 Combined HSG & hysteroscopy & clinical

31. Intrauterine Synechiae Severe Moderate

38. Resection of the Uterine Septum 121 Laparoscopic Guided Septum Collin's Electrode

40. Proximal Tubal Obstruction (PTO)

44. Tubal Catheterization Bilateral Cornual Block Amorphous material R. Ovary R. fimbria Cornual catheterization

47. Thank You