Hysteroscopy in the evaluation of female infertility.

Endometrial and tubal causes of female infertility have been sought with the use of endometrial biopsy, the Rubin test, hysterosalpingography, and laparoscopy. Hysteroscopy, used as an adjunct to these methods, can increase their effectiveness in evaluating uterine or tubal factors that may account directly or indirectly for reproductive failure. Hysteroscopy was included in the diagnostic evaluation of 142 patients with a diagnosis of primary or secondary infertility. In 62%, visually recognizable abnormalities were found, such as intrauterine adhesions, endometrial polyps, submucous leiomyomas, and uterine septa, that could explain the infertility. In 31.7% of 63 patients who had an abnormal hysterosalpingogram, hysteroscopy demonstrated a normal uterine cavity. Even though hysteroscopy is useful as a diagnostic and therapeutic adjunct to traditional methods for evaluation of uterine factors in infertility, it does not replace or exclude them. Rather, it complements the procedures, particularly when abnormal hysterosalpingograms have been obtained, when intrauterine adhesions are suspected, or when there is abnormal uterine bleeding. Performed concomitantly with laparoscopy, hysteroscopy becomes the most effective technique for evaluation of the uterine and tubal conditions that may play a role in female infertility.