Pundir Jyotsna, El Toukhy Tarek
ACU, Guy's & St Thomas' NHS Trust, London, UK.
Womens Health (Lond). 2010 Nov;6(6):841-7; quiz 847-8. doi: 10.2217/whe.10.61.
Approximately 15% of couples are affected with subfertility, of which up to 20% remain unexplained. Uterine cavity abnormalities can be a contributing cause of subfertility and recurrent implantation failure. Uterine cavity assessment has been suggested as a routine investigation in the evaluation of subfertile women. Traditionally, hysterosalpingography has been the most commonly used technique in the evaluation of infertility. Transvaginal ultrasound scan allows visualization of the endometrial lining and cavity, and has been used as a screening test for the assessment of uterine cavity. Abnormal uterine findings on a baseline scan can be further evaluated with saline hysterosonography, which is highly sensitive and specific in identifying intrauterine abnormalities. Hysteroscopy is considered as the definitive diagnostic tool to evaluate any abnormality suspected on hysterosalpingography, transvaginal ultrasound scan or saline hysterosonography during routine investigation of infertile patients. Minimally invasive hysteroscopes have minimized the pain experienced by patients during the procedure and made it feasible to use hysteroscopy as a routine outpatient examination. Following recurrent IVF failure there is some evidence of benefit from hysteroscopy in increasing the chance of pregnancy in the subsequent IVF cycle, both in those with abnormal and normal hysteroscopic findings. Various possible mechanisms have been proposed for this beneficial effect, but more randomized controlled trials are needed before its routine use in the general subfertile population can be recommended.
约15%的夫妇受到生育力低下的影响，其中高达20%的病因仍不明。子宫腔异常可能是生育力低下和反复种植失败的一个促成原因。子宫腔评估已被建议作为评估生育力低下女性的常规检查。传统上，子宫输卵管造影是评估不孕症最常用的技术。经阴道超声扫描可观察子宫内膜和子宫腔，已被用作子宫腔评估的筛查试验。基线扫描发现子宫异常可进一步通过盐水子宫超声造影进行评估，其在识别子宫内异常方面具有高度敏感性和特异性。宫腔镜检查被认为是评估不孕患者常规检查中子宫输卵管造影、经阴道超声扫描或盐水子宫超声造影怀疑的任何异常的确定性诊断工具。微创宫腔镜已将患者在手术过程中所经历的疼痛降至最低，并使宫腔镜作为常规门诊检查成为可能。在反复体外受精失败后，有证据表明，无论是宫腔镜检查结果异常还是正常的患者，宫腔镜检查都有助于提高后续体外受精周期的妊娠几率。对于这种有益效果，已经提出了各种可能的机制，但在推荐其在一般生育力低下人群中常规使用之前，还需要更多的随机对照试验。
