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Chromohysteroscopy and Laparoscopy Findings in Infertile Patients with Persistent Midluteal Phase Central Endometrial Echo

Abstract

Abdel-Gadir A

Objective: To study the relationship between persistent midluteal central endometrial echo versus polycystic ovaries and chromohysteroscopy and laparoscopy findings in infertile patients with regular menstruation.

Material and methods: 164 infertile patients with regular menstruation were investigated with ultrasound monitored cycles followed by chromohysteroscopy and laparoscopy. Persistent midluteal central endometrial echo was assessed against presence of polycystic ovaries, micropolyps and deep endometrial staining with methylene blue and presence of endometriosis diagnosed laparoscopically.

Results: 51 patients (31.1%) showed persistent central midluteal endometrial echo and 72 (43.9%) showed polycystic ovaries. During chromohysteroscopy 21 patients (12.8%) showed micropolyps and 26 (15.9%) showed deep endometrial staining with methylene blue. Moreover, 30/51 patients with central midluteal endometrial echo (58.8%) showed polycystic ovaries versus 42/113 patients (37.2%) with homogeneous endometrium, p=0.011. Furthermore, 18/51 patients (35.3%) with central endometrial echo showed dark endometrial discolouration with methylene blue versus 08/113 patients (7.1%) with homogenous endometrium, p<0.001. Similarly, 14/51 patients (27.5%) with central midluteal endometrial echo showed micropolyps versus 7/113 (6.2%) with homogeneous endometrium, p=0.001. Polycystic ovaries showed no significant association with either sign of chronic endometritis. During laparoscopy, 31/164 patients (18.9%) showed pelvic endometriosis. 14 of them (45.2%) developed deep endometrial discolouration with methylene blue versus 12/113 patients (9.0%) without endometriosis, p<0.001. Likewise, 21/31 patients with endometriosis (67.7%) had central midluteal endometrial echo versus 30/133 patients (22.6%) with no endometriosis, p<0.001. This association was maintained after excluding patients with chronic endometritis.

Conclusion: Persistent midluteal central endometrial echo might reflect chronic endometritis as it was significantly associated with deep endometrial discolouration with methylene blue and micropolyps. The significant association between endometriosis and midluteal central endometrial echo in cases with and without chronic endometritis indicated that endometriosis might affect the endometrium through more than one mechanism. Conversely, the association of polycystic ovaries with midluteal endometrial echo was independent of chronic endometritis.