Endometrial pathology is a well-recognized contributor to infertility and recurrent implantation failure, with reported prevalence rates exceeding 30%.7 Despite the simplicity and safety of hysteroscopy in evaluating the uterine cavity, its ability to detect endometrial pathology in the absence of intracavitary lesions is limited. To enhance the detection rate of subtle endometrial pathology after diagnostic hysteroscopy, we employed the use of methylene blue dye, a substance commonly used in gastrointestinal imaging.9 The rationale behind this was the postulation that damaged cells would allow the passage of methylene blue dye.
Our study demonstrated a significantly higher diagnostic accuracy for chromohysteroscopy compared to conventional hysteroscopy (92% vs. 58%) in the detection of endometrial pathology.
The mean age of the study population was 28 years, with the majority falling within the 26–30 years age range. This relatively young age can be attributed to early marriages, which consequently contribute to the years of infertility. These findings align with previous studies on chromohysteroscopy, which also reported mean ages of 27–29 years.10–11
In our study, 76% of women had normal hysteroscopic findings, while 24% had abnormal findings. Interestingly, among the 76 women with normal hysteroscopy, 34.2% had abnormal histological results. Conversely, 96.77% of cases (60/62) with diffuse light staining area had normal histological findings. This highlights the high specificity of chromohysteroscopy in detecting endometrial pathology, a finding consistent with other studies, including Kucuk et al.11
Furthermore, among the 34 cases with abnormal endometrial histology, 32 exhibited dark staining during chromohysteroscopy, indicating a strong correlation between staining patterns and endometrial pathology. Similar findings were reported in studies by Vijay et al.12 and Mansour et al.,13 emphasizing the usefulness of chromohysteroscopy in diagnosing subtle endometrial changes.
Comparing histopathology results between the dark-stained and unstained areas within the dark-stained group (N = 38), the power of dark staining to detect endometrial pathology was statistically significant (p = 0.003). This aligns with studies by Haider et al. wherein they demonstrated a sensitivity of 83.3% with diagnostic accuracy of 82.8% of dark staining area in detecting endometrial pathology, and they concluded that the difference in the diagnostic ability of stained tissue biopsy was highly significant (p < 0.001) when compared to blind endometrial aspiration biopsy.14 Singh et al. also demonstrated the superiority of stained tissue biopsy over unstained tissue biopsy in diagnosing endometrial pathology.15 In the current study, the most frequently observed histological condition was tuberculous endometritis, followed by chronic endometritis and endometrial hyperplasia. Conversely, in a study conducted by Kucuk et al., which involved 64 women experiencing IVF failure, chronic endometritis was reported as the most common endometrial pathology. This disparity in findings could potentially be attributed to the high prevalence of genital tuberculosis in our country.
In the current study, chromohysteroscopy demonstrated a diagnostic accuracy of 92% for detecting endometrial pathology, in contrast to the 58% accuracy observed with simple hysteroscopy. These findings align with a previous study conducted by Gupta et al., which reported a diagnostic accuracy of 86.67% for chromohysteroscopy in the evaluation of endometrial pathology. These findings suggest that this approach can significantly improve the accuracy of diagnosis and guide clinicians in providing more targeted and effective treatments for patients experiencing fertility challenges. Overall, the chromohysteroscopy stands as a promising advancement in the field of reproductive medicine, offering enhanced insights into endometrial health and contributing to improved patient care.