Endometrial Evualuation in Infertility: Study of 50 Cases

BACKGROUND:: Various disorders lead to infertility in women of reproductive ages. This study was performed to describe the common ENDOMETRIAL causes of infertility and sonographic ,histerosalpingographic, and endometrial biopsy evaluation of these causes for midwives. IntroductionSuccessful implantation depends on interaction between a blastocyst and receptive endometrium. Different strategies have been developed to evaluate endometrial receptivity, such as the histologic dating of an endometrial biopsy or more commonly a non-invasive ultrasound examination of the endometrium. Aims and objectivesTo study the endometrialstatus in infertility cases by following parameters: 1.TVSon day 12-13 (pre ovulatory period) -endometrial thickness, pattern and sub-endometrial blood flow. 2.HSG-also used for evaluation of uterine cavity. 3.Histopathology and TB PCR of premenstrual endometrial biopsy. Material and methods: It is a prospective study, carried out in the Department of Obstetrics and Gynecology, Institute of Medical Sciences in collaboration with the Department of Radiodiagnosis, Banaras Hindu University, over a period of 2 years. Hundred patients with infertility attending Female OPD (FOPD) of SSH, BHU were the subject. Patients complaining of infertility, aged 19-45 years, sexually active were subjected to detailed history & clinical examination, HSG, TB PCR and histopathology of premenstrual endometrial tissue and TVS & color Doppler study (endometrial thickness, pattern and vascularity). Measurements were analyzed relative to outcome. Results: Maximum rate of conception was seen with endometrial thickness 10-14mm (61.54%) and with triple line pattern of endometrium. There was no conception in zone I flow and maximum conception rate (25%) was seen when zone III flow was present. Majority of patients with genital tuberculosis had their endometrial thickness <7mm and absent triple line endometrium reflects poor receptivity of the endometrium and local endometrial factor as a cause for infertility. Conclusion: Our results show that no single parameter is specific enough to predict conception. Further study is needed to make a definitive conclusion. MANJARI MATAH PROFESSOR DEPARTMENT OF OBSTEREISTIC & GYNACOLOGY IMS BHU VARANASI U.P. INDIA 39 International Journal of Scientific Research ISSN No 2277 8179 | IF : 4.176 | IC Value : 78.46 VOLUME-6 | ISSUE-6 | JUNE-2017 Doppler and TB-PCR, HPE test of endometrial sample. After consent proper history was taken including name, age, years of marriage, type of infertility, present complaints, menstrual cycles, medical illness and its treatment or surgical intervention if any followed by through clinical examination done including local n systemic examination. Then they are gone under investigation including 1. Pelvic USG with Colour Doppler 2. Hysterosalpingogram (HSG) 3. TB-PCR and histopathology of endometrial tissue STATISTICAL ANALYSIS The statistical analysis was done using SPSS (Statistical Package for the Social Sciences version 16. for Windows version 16.0 software). The Chisquare and Fisher’s test was used. P<0.05 were considered to be statistically significant. RESULTS AND DISCUSSION Among patients evaluated, 77% cases were of primary infertility, 23% of secondary infertility. Among patients evaluated, maximum patients (42%) had tubal factor (HSG), 22% had positive endometrial TB PCR, 17% had nonsecretory endometrium in HPE of premenstrual endometrial biopsy (anovulatory cycles) and 12 % had PCOS. The etiology was unexplained in 28% cases after work up. Forty-two (42%) patients were in age group of 19-25 years, whereas 41% patients were in age group of 26-30 years, 14% in age group of 3135 years and 3% were >35 year age group. Maximum patients (66%) had 1-5 years duration of infertility, 25% with duration of 5.1-10 years and 9% had duration more than 10 years. Mean duration of infertility was 4.895 years. 49% of patients under study had education upto matriculation, 47% had upto graduation / post-graduation and 4 % were illiterate. Approximately half of patients (51%) belonged to rural area and half (49%) of them belonged to urban area. In rural habitat, 47.06% patients had tubal factor, 17.65% had endometrial TB PCR positive, 13.73% had anovulatory cycle, 5.88% had PCOD and 23.5% had unexplained infertility. In urban habitat, 36.73% patients had tubal factor, 26.53% had endometrial TB PCR positive, 20.41% had anovulatory cycle, 18.37% had PCOD and 32.65% had unexplained infertility. Majority of the patients (45%) belonged to lower middle class followed by 34% to middle class, 11% to upper middle class, 8% to lower class and 2% to upper class. Maximum patients (82%) were housewife, only 18% were working. Majority of the patients (68%) had BMI between 18.5-24.99 kg/m2, 15% had <18.5, 15 % had between 25-29.99 and 2% had BMI >30