Comparing endometrial hysteroscopic and histological findings of infertile women with polycystic ovary syndrome and unexplained infertility: A cross-sectional study.

Amooee S, Mojgan Akbarzadeh‐Jahromi, Motavas M, Zarei F
International journal of reproductive biomedicine · 2019 · doi:10.18502/ijrm.v18i1.6195 · PMID:32043069 · PMC6996121
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This cross-sectional study compared hysteroscopic and histological findings in infertile women with polycystic ovary syndrome and unexplained infertility, revealing that hysteroscopy alone may fail to detect endometrial pathologies in patients with polycystic ovary syndrome.

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This retrospective cross-sectional study compared endometrial hysteroscopic and histological findings in 105 infertile women with polycystic ovary syndrome (PCOS) versus those with unexplained infertility, specifically focusing on patients with normal endometrial thickness on ultrasonography. The results indicated that while all PCOS patients had normal hysteroscopic appearances, histological analysis revealed a high prevalence of disorders such as proliferative or disordered proliferative endometrium, whereas the unexplained infertility group showed different patterns dominated by secretory endometrium. The authors concluded that direct visualization via hysteroscopy may be insufficient for detecting endometrial abnormalities in PCOS patients, highlighting the necessity of histological evaluation even when ultrasound and visual inspections appear normal. This paper is centrally about endometriosis — specifically laparoscopic excision of deep infiltrating lesions.

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Abstract

BackgroundInfertility is a critical condition in women with polycystic ovary syndrome (PCOS), caused not only by anovulation but also by endometrial abnormality.ObjectiveThis study aimed to evaluate and compare the hysteroscopic and histological findings of endometrial biopsies in infertile women with PCOS and normal endometrial thickness and women with unexplained infertility (UI).Materials and methodsThis cross-sectional study compared the initial hysteroscopy and endometrial histological findings of 70 infertile women with PCOS and normal endometrial thickness with those of 35 women with UI. The relationship between endometrial histology and clinical parameters such as including luteinizing hormone, follicle-stimulating hormone, thyroid-stimulating hormone, testosterone, prolactin, fasting blood sugar, body mass index (BMI), and infertility duration was analyzed.ResultsThe mean age of women with PCOS was significantly lower than that of women with UI (27.5 ± 4.1 vs. 30 ± 4.5 years, respectively) (p < 0.001). The mean BMI was higher in women with PCOS than in women with UI (28.7 ± 4.4 vs. 25.1 ± 3 kg/m 2 ) (p < 0.001). The hysteroscopic findings of all women with PCOS were normal, whereas 91.4% of women with UI had normal hysteroscopic findings, 2.9% had a polyp, and 5.7% had endometrial thickening. The histological findings of women with PCOS revealed proliferative endometrium in 54.3%, disordered proliferative endometrium in 17.1%, secretory endometrium in 8.6%, and endometrial polyp in 17.1%, whereas these percentages in women with UI were 28.6%, 0%, 54.3%, and 20%, respectively.ConclusionThe hysteroscopic evaluation alone of infertile women might not detect all probable endometrial pathologies in women with PCOS.
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The present study revealed that normal hysteroscopic findings were associated with abnormal endometrial biopsies in some infertile women with PCOS without endometrial thickening, suggesting that hysteroscopic evaluation alone of infertile women without histological studies might not be able to detect probable endometrial pathologies such as micropolyps. Therefore, performing hysteroscopic and histological evaluations is recommended in all women with PCOS even in cases with no endometrial thickening or other abnormalities detected on ultrasonography.

Coi Statement

There are no conflicts of interest.

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