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Hysteroscopy procedure and its role in infertility

Hysteroscopy is a form of minimally invasive surgery. Hysteroscopy procedure involves an examination of the inside of the uterus or womb. The examination is conducted with a thin telescope. The examination is a vital part of the procedure that helps doctors investigate and detect possible intrauterine changes that could interfere with implantation or growth, or both, of the embryo. Upon investigating possible issues, doctors customize a plan for restoring a normal endometrial environment for achieving pregnancy.
Hysteroscopy is an effective way to treat uterine pathologies, which is a condition of the thickening of the endometrium. Being one of the main causes of infertility in as many as 15% of couples seeking treatment and as many as 50% of infertile patients in general, the hysteroscopy procedure is useful in such cases.
How is hysteroscopy performed?

  • After general anaesthesia is given the surgeon inserts a tiny telescope (Hysteroscope) through the cervix into the uterus using a salt solution to distend the uterus and obtain visualization of the uterine cavity.
  • The surgeon examines the shape of the uterus, openings to the fallopian tubes, and the lining of the uterus and looks for any evidence of intrauterine pathology, commonly known as fibroids or polyps.
  • After completing the inspection of the uterine cavity, different instruments may be inserted according to the diagnosed issue. This procedure is done through the hysteroscope to remove uterine fibroids, polyp, adhesions, and septum.

Uses of hysteroscopy:
Diagnostic hysteroscopy evaluation of the uterine cavity is a basic step in female infertility workup. Transvaginal sonography and hysterosalpingography are most commonly used to understand a patient’s infertility issues. Hysteroscopy, however, is considered the gold standard or the most common procedure for the diagnosis of intrauterine lesions.
Why is hysteroscopy done?
For removal of endometrial or cervical polyps: Polyps are localized overgrowth of the endometrium.

  • 10—32% of an infertile couple may have asymptomatic endometrial polyps.
  • Polyp can distort the endometrial cavity and may have a detrimental effect on endometrium receptivity and increase the rate of implantation failure.
  • Hysteroscopic removal of polyps before IUI and also in case of recurrent implantation failure after IVF increases pregnancy rate

For Removal of Myomas – Submucous myoma having at least 50% of the volume within the uterine cavity or intracavitary myoma that can block fallopian tubes which makes it difficult for the egg and sperm to meet. This increases cytokine production which can impact the uterus. It can alter uterine receptivity and causes poor implantation of the egg leading to failed pregnancies. If doctors feel that myomas are large may require two surgeries to completely remove them safely.
For Biopsies – An endometrial biopsy is a popular practice by infertility specialists such as Dr. Manish Banker himself in case of poor endometrium or thin endometrium. This helps doctors rule out possible diseases such as tuberculosis infections.
For Cannulation or opening of the fallopian tubes:
In the case of Proximal Tubal Block or blocked fallopian tubes, Hysteroscopic tubal cannulation appears to be more effective than fluoroscopic guided cannulation or open microsurgical repair. Blocked fallopian tubes occur in 10 to 25% of infertile women. It leads to obstruction of the anatomic pathway for fertilization, where the egg and sperm meet.
For Asherman’s Syndrome or Adhesions-
Hysteroscopy is also done for the removal of intrauterine adhesions (scarring) that may occur because of infection or from past surgeries.
Metroplasty is done in case of Septate uterus with recurrent miscarriage – partial or complete septa can be removed.
Before ART – Hysteroscopy is also performed to increase the chance of pregnancy in the subsequent IVF cycles who had one or two failed IVF cycles. This allows the diagnosis and treatment of intrauterine pathology, for those who may have had a normal hysterosalpingogram before their IVF cycle.
Hysteroscopy procedure is a recommended and ideal procedure to evaluate female infertility. The recovery time is very quick. Almost all the patients go home the same day following hysteroscopic surgery. If you liked this blog, then visit our blog page for more important topics such as the connection between age and infertility, counselling for infertility, etc.

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