Most of these factors are detected by hysterosalpingography and confirmed by hysteroscopy. There is also increasing inter est in the use of ultrasonography in combination with fluid distention of the uterus to evaluate uterine anomalies. Endometritis is identified by endometrial biopsy and culture. Acute endometritis, which is associated with instrumen tation of the uterus, foreign bodies, or gonorrhea, may cause transient infertility but is usually self-limiting. Occasion ally a retained intrauterine device or fetal tissue is detected.
Chronic endometritis is likely to be a cause in longstanding infertility.
Persistent pelvic adhesions may occur as a consequence of previous inflammatory conditions such as pelvic inflam matory disease, endometriosis, appendicitis with rupture, ruptured ovarian cysts such as dermoids, previous surgery, and foreign-body reaction. However, it can affect other sites such as ab dominal viscera, urinary tract, and lungs. Although histologically benign, it has a unique ability to invade and destroy tissues and cause severe inflammation and adhesion forma tion. It is im portant that the etiology of ovulatory disorders be determined before initiation of therapy to aid in selection of the appropriate treatment method and to rule out sig nificant disease. Anovulation is presumed in women with a menstrual cycle length of 42 days or more and in women with amenorrhea, in the absence of intrauterine synechiae.