Abstract:
Infertility is a common problem that affects approximately 80 million people worldwide, one in ten couples is faced with primary or secondary infertility. Hysteroscopy is increasingly taking an important place in the management of this pathology. The main objective of this work is to evaluate the place of hysteroscopy as well on the diagnostic, etiological as well as therapeutic level of female infertility. Epidemiologically, the frequency of uterine anomalies is 50%, uterine synechiae are the most frequently found etiology with a frequency of 23%, uterine septa at 17%, polyps at 11%, polyps at 10% and finally intracavitary myomas with a frequency of 9%. Our study is retrospective analytical carried out at the gynecology-obstetrics department 2, mother-child hospital, at the CHU HASSAN II of Fez, over a period of 3 years (2018-2021), are included in this study 18 patients suffering from primary infertility or secondary, who underwent a hysteroscopy (5.6%) as part of the diagnostic and therapeutic approach out of 320 patients who consulted the ART unit for infertility, despite the cessation of activity in our unit for a few months, in 2020 because of the Covid 19 pandemic. An operating sheet was established and the data was collected through the infertility files in the archive of our unit. The average age of women was 29.4 years (20-43 years), with an average duration of infertility of 3.27 years (2 years-10 years). Hysteroscopy was abnormal in 55.5% of cases showing synechiae (16.66%), polyps (11.11%), uterine septa (11.11%), myoma (5.5%), endometritis (5%) and trophoblastic retention in a single case. Operative hysteroscopy was performed in 38.3% of the total number of patients who underwent hysteroscopy, distributed between release and resection of synechiae (22.2%), septum resection (11.5%), septoplasty (11.5%), extraction of the retention (11.5%), with obtaining spontaneous pregnancies after synechia and septal cures. Through a large review of the literature and our experience, we concluded that despite the rarity of infertility of solely uterine origin compared to other factors such as the age of the patient, biological factors, the current study has shown that intra-uterine lesions are frequent in infertile women and are likely to influence the prognosis of spontaneous fertility or in medically assisted procreation. Hysteroscopy is currently the reference examination for the diagnosis of intrauterine lesions. Although its benefit as a first-line examination in the exploration of the uterine cavity in the initial assessment of infertility remains uncertain and presents a subject of debate in the literature, other studies, especially prospective studies with a large population are necessary to better place hysteroscopy in the therapeutic arsenal .
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