Chronic endometritis: is it the last limit of ultra sounding in the exploration of the endometer? Ultrasound versus hysteroscopy: 3-year study. Z.Farah-I.Bounab-S.Boubezoul-S.Ramda-R.Khodja Bologhine hospital – gynecology department – Algiers –Algeria

INTRODUCTION: The exploration of the endometrium is a decisive step in the management of infertility, especially in PMA. Failures of implantation remain unexplained in a number of cases. The quality of the endometrium is partly responsible for these failures, especially in cases of chronic endometritis. The diagnosis of the great majority of intracavitary lesions is possible with ultrasoud,but it remains limited in the case of Fig 3-4 :hysteroscopic appearance of hemorragea endometriosis as bacteriological or histological evidence is necessary. We report the experience of our departement over 3years.

MATERIAL AND METHOD :Transversal study over a period of 3 years in 52 cases of infertile patients in AMP ,we evaluated the hysteroscopic indications and then we compared the echographic diagnosis, the hysteroscopic aspect to the results of the anatomopathological diagnosis. Fig 5: endometrial hypertrophy Fig6: endometrial atrophy

RESULTS: Mean age 34 ± 2.4 years, patients are referred for these DISCUSSION indications : implantation failures in 30.4% ; for polyp in The concordance between the 16.6% and for systematic hysteroscopy pre-AMP in echographic and hysteroscopic aspect is 53.2% of cases. found in cases of polyps, hypertrophy of Ultrasonography revealed polyps in 19% of cases, the endometrium, but in case of adenomyosis 8%, endometrial hypertrophy 4% , and endometritis the ultrasound gives no without abnormalities in 69%. particular information. hysteroscopy found an appearance of micropolyps and The hysteroscopic aspects found were as follows: 24% localized hemorrhage in 15% of cases, endo-cavity polyp, 5.5% endometrial hypertrophy (fig 5), and anapath confirms this diagnosis in 11 4.5% adenomyosis, 8.5% endometrial atrophy (fig6), cases, including uterine tuberculosis : the endometritis appearance 15% : micropolyps(fig 1-2) - hysteroscopic aspect was probably haemorrhage (fig 3-4) atrophy of the endometrium. endometrium without abnormalities 42.5% The anapath study of the endometrial biopsy found 2 Conclusion: cases of tuberculous endometritis (3.8%) and 9 cases In our study Hysteroscopy has a (17.3%) of infectious endometritis (Chlamydia- superiority in the diagnosis of chronic Ureaplasma), therefore 11 cases of endometritis ( 21.1%) endometritis compared to ultrasound. Even if the endometrial aspect of the endometrium seems normal, the histological verification of the endometrium seems important especially in infertility and pre-PMA.

Fig 1-2 : hysteroscopic appearance of micropolyps