Publication:

Endometrial hysteroscopic and histopathological characteristics in infertile women with polycystic ovary syndrome versus unexplained infertility: a comparative cross-sectional study

Background Polycystic ovary syndrome (PCOS) affects 5-15% of reproductive-aged women and accounts for nearly 90–95% of anovulatory infertility. Beyond ovulatory dysfunction, PCOS is associated with insulin resistance, obesity, chronic inflammation, and increased metabolic and atherogenic risk. These factors predispose to endometrial dysfunction, hyperplasia, and carcinoma, contributing to implantation failure and miscarriage. Hence, evaluation of endometrial abnormalities in PCOS is essential for comprehensive infertility management. Aim of the study was to compare hysteroscopy and histopathological endometrial findings in infertile women with PCOS and unexplained infertility (UI), and to correlate clinical and hormonal profiles between the groups.

Methods A cross-sectional analytical study conducted over two years in a tertiary care obstetrics and gynecology center. A total of 165 infertile women were included (85 with PCOS, 80 with UI). After informed consent, detailed clinical evaluation was performed. Hormonal profile and pelvic ultrasound were done on day 2 of menstruation. Diagnostic laparoscopy, hysteroscopy, laparoscopic ovarian cautery (where indicated), and endometrial biopsy were performed. Clinical, hormonal, hysteroscopic, and histopathological findings were compared between both the groups. Statistical analysis was done using statistical package for the social sciences (SPSS) v26; p<0.05 was considered significant.

Results Women with PCOS were younger and had significantly higher BMI and longer duration of infertility than UI (p<0.05). Day-2 endometrial thickness was significantly higher in PCOS (7.5±1.8 mm versus 5.6±1.7 mm). Hysteroscopy was normal in 82% of PCOS and 70% of UI women. Micropolyps and hyperemic endometrium were more frequent in PCOS, while polyps, adhesions, and uterine anomalies predominated in UI. Histologically, PCOS showed higher rates of proliferative and disordered proliferative endometrium, with endometrial hyperplasia detected in 8.4%, compared to none in UI.

Conclusions Normal hysteroscopic findings do not reliably indicate a normal endometrial milieu in PCOS. Routine endometrial biopsy alongside hysteroscopy may uncover subclinical pathology and improve infertility management in this population.