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Virtual ultrasonographic hysteroscopy followed by conventional operative hysteroscopy, enabling pregnancy

Virtual ultrasonographic hysteroscopy followed by conventional operative hysteroscopy, enabling... Images in Gynecology ajog.org Virtual ultrasonographic hysteroscopy followed by conventional operative hysteroscopy, enabling pregnancy Jan Tesarik, MD, PhD; Raquel Mendoza-Tesarik, PhD; Nicolas Mendoza, MD, PhD Case Note FIGURE A 35-year-old woman presented with premature menopause and Uterine cavity images by conventional and virtual previous failure of oocyte donation; our pregnancy rate for this hysteroscopy procedure is 80%. She had undergone, at another clinic, operative hysteroscopy intervention during which 2 polyps were removed. However, this last intervention was followed by inflammatory complications. We decided to perform virtual ultrasonographic hysteroscopy as a more patient-friendly procedure. This intervention was performed by transvaginal ultrasono- graphic examination using “fly-through” technology (Fly Thru, Toshiba American Medical Systems, Tustin CA) enabling computerized 4-dimensional virtual reconstruction of the uter- ine cavity, without the need for physically entering the uterus. Her uterine cavity was slightly distended by injecting 10 mL of saline through a narrow soft balloon catheter fixed to the cervical canal. Immediately thereafter, images of the cavity were taken (Video 1). The whole procedure took <10 minutes. As compared to con- ventional saline-infusion sonography, fly-through technology makes it possible to minimize the volume of injected saline without compromising image quality. Image analysis showed a beamlike adhesion crossing the uterine cavity (Figure,A,and Video 1). Conventional hysteroscopy was thus performed 2 days later, under general anesthesia. The uterine adhesion was visu- alized (Figure,B)and removed(Figure, C). One month later, virtual ultrasonographic hysteroscopy was repeated to evaluate A, Virtual and B, conventional hysteroscopy of uterine cavity showing the result of the previous hysteroscopic surgery. The images beamlike intracavital adhesion (arrow). C, Removal of adhesion by con- showed complete disappearance of the intracavital adhesion in its ventional hysteroscopy. D, Repeated virtual hysteroscopy of region from previous location (Figure,D,and Video 2). The patient thus which intracavital adhesion was removed. prepared for transfer of her cryopreserved embryos, resulting Tesarik. Virtual and conventional hysteroscopy. Am J Obstet Gynecol 2017. from the previous oocyte donation attempt. After conventional uterine preparation protocol, 2 embryos were transferred, Comment resulting in an ongoing singleton pregnancy. These observations show that virtual ultrasonographic hyster- oscopy can be used as the first-line, patient-friendly method for From the MARGen Clinic, Granada, Spain (all authors) and Department of detection of uterine cavity pathologies, followed, if necessary, by Obstetrics and Gynecology, University of Granada, Granada, Spain (Dr N. conventional operative hysteroscopy. The image quality is Mendoza). comparable with that obtained by computerized tomography Received July 29, 2016; revised Sept. 4, 2016; accepted Sept. 7, 2016. and magnetic resonance imaging. In a broader sense, this The authors report no conflict of interest. minimally invasive technique can be considered for examina- Corresponding author: Jan Tesarik, MD, PhD. jtesarik@clinicamargen.com tion of other body cavities, such as preovulatory ovarian folli- Cite this article as: Tesarik J, Mendoza-Tesarik R, Mendoza N. Virtual cles, embryonic sacs, urinary bladder, or large blood vessels.- ultrasonographic hysteroscopy followed by conventional operative hysteroscopy, enabling pregnancy. Am J Obstet Gynecol 2017;216:188.e1. REFERENCES 0002-9378 ª 2016 The Author(s). Published by Elsevier Inc. This is an open access article under 1. Tesarik J, Mendoza C, Greco E. Paternal effects acting during the first the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). cell cycle of human preimplantation development after ICSI. Hum Reprod http://dx.doi.org/10.1016/j.ajog.2016.09.081 2002;17:184-9. 2. Carrascosa P, Capuñay C, Vallejos J, et al. Two-dimensional and three- dimensional imaging of uterus and fallopian tubes in female infertility. Fertil Click Video under article title in Contents at Steril 2016;105:1403-20. 188.e1 American Journal of Obstetrics & Gynecology FEBRUARY 2017 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Obstetrics and Gynecology Wolters Kluwer Health

Virtual ultrasonographic hysteroscopy followed by conventional operative hysteroscopy, enabling pregnancy

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Publisher
Wolters Kluwer Health
Copyright
Copyright © 2016 The Author(s)
ISSN
0002-9378
DOI
10.1016/j.ajog.2016.09.081
pmid
27640941
Publisher site
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Abstract

Images in Gynecology ajog.org Virtual ultrasonographic hysteroscopy followed by conventional operative hysteroscopy, enabling pregnancy Jan Tesarik, MD, PhD; Raquel Mendoza-Tesarik, PhD; Nicolas Mendoza, MD, PhD Case Note FIGURE A 35-year-old woman presented with premature menopause and Uterine cavity images by conventional and virtual previous failure of oocyte donation; our pregnancy rate for this hysteroscopy procedure is 80%. She had undergone, at another clinic, operative hysteroscopy intervention during which 2 polyps were removed. However, this last intervention was followed by inflammatory complications. We decided to perform virtual ultrasonographic hysteroscopy as a more patient-friendly procedure. This intervention was performed by transvaginal ultrasono- graphic examination using “fly-through” technology (Fly Thru, Toshiba American Medical Systems, Tustin CA) enabling computerized 4-dimensional virtual reconstruction of the uter- ine cavity, without the need for physically entering the uterus. Her uterine cavity was slightly distended by injecting 10 mL of saline through a narrow soft balloon catheter fixed to the cervical canal. Immediately thereafter, images of the cavity were taken (Video 1). The whole procedure took <10 minutes. As compared to con- ventional saline-infusion sonography, fly-through technology makes it possible to minimize the volume of injected saline without compromising image quality. Image analysis showed a beamlike adhesion crossing the uterine cavity (Figure,A,and Video 1). Conventional hysteroscopy was thus performed 2 days later, under general anesthesia. The uterine adhesion was visu- alized (Figure,B)and removed(Figure, C). One month later, virtual ultrasonographic hysteroscopy was repeated to evaluate A, Virtual and B, conventional hysteroscopy of uterine cavity showing the result of the previous hysteroscopic surgery. The images beamlike intracavital adhesion (arrow). C, Removal of adhesion by con- showed complete disappearance of the intracavital adhesion in its ventional hysteroscopy. D, Repeated virtual hysteroscopy of region from previous location (Figure,D,and Video 2). The patient thus which intracavital adhesion was removed. prepared for transfer of her cryopreserved embryos, resulting Tesarik. Virtual and conventional hysteroscopy. Am J Obstet Gynecol 2017. from the previous oocyte donation attempt. After conventional uterine preparation protocol, 2 embryos were transferred, Comment resulting in an ongoing singleton pregnancy. These observations show that virtual ultrasonographic hyster- oscopy can be used as the first-line, patient-friendly method for From the MARGen Clinic, Granada, Spain (all authors) and Department of detection of uterine cavity pathologies, followed, if necessary, by Obstetrics and Gynecology, University of Granada, Granada, Spain (Dr N. conventional operative hysteroscopy. The image quality is Mendoza). comparable with that obtained by computerized tomography Received July 29, 2016; revised Sept. 4, 2016; accepted Sept. 7, 2016. and magnetic resonance imaging. In a broader sense, this The authors report no conflict of interest. minimally invasive technique can be considered for examina- Corresponding author: Jan Tesarik, MD, PhD. jtesarik@clinicamargen.com tion of other body cavities, such as preovulatory ovarian folli- Cite this article as: Tesarik J, Mendoza-Tesarik R, Mendoza N. Virtual cles, embryonic sacs, urinary bladder, or large blood vessels.- ultrasonographic hysteroscopy followed by conventional operative hysteroscopy, enabling pregnancy. Am J Obstet Gynecol 2017;216:188.e1. REFERENCES 0002-9378 ª 2016 The Author(s). Published by Elsevier Inc. This is an open access article under 1. Tesarik J, Mendoza C, Greco E. Paternal effects acting during the first the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). cell cycle of human preimplantation development after ICSI. Hum Reprod http://dx.doi.org/10.1016/j.ajog.2016.09.081 2002;17:184-9. 2. Carrascosa P, Capuñay C, Vallejos J, et al. Two-dimensional and three- dimensional imaging of uterus and fallopian tubes in female infertility. Fertil Click Video under article title in Contents at Steril 2016;105:1403-20. 188.e1 American Journal of Obstetrics & Gynecology FEBRUARY 2017

Journal

American Journal of Obstetrics and GynecologyWolters Kluwer Health

Published: Feb 1, 2017

References