Hysteroscopy for IVF: Is Hysteroscopy Must for Successful IVF?

If you have been on a quest to know about fertility problems and are considering IVF treatment as a remedy, then you would have read or heard about hysteroscopy for IVF. 
In this blog, you will understand what hysteroscopy is, why hysteroscopy is it done, and everything about hysteroscopy for IVF. Let us first understand what hysteroscopy is!

What is Hysteroscopy?

A form of minimally invasive surgery performed using a flexible telescope, hysteroscope, is referred to as hysteroscopy. Hysteroscopy is a surgical procedure that encompasses an inner examination of the uterine cavity. The examination assists doctors to evaluate and detect potential intrauterine changes, which can interfere with the implantation or growth of the embryo. 
Simply put, with hysteroscopy, conditions that contribute to recurrent pregnancy losses and female infertility can be diagnosed. Moreover, hysteroscopy has been ascertained to raise the in vitro fertilization/ IVF success rates. Plus, by performing hysteroscopy, the removal of polyps or uterine fibroids is also achievable. 
Hysteroscopy is indeed a beneficial means of treating uterine pathologies, which are conditions caused by endometrial thickening. The hysteroscopy procedure is useful in such cases because it is one of the main causes of infertility in up to 15% of couples seeking treatment and up to 50% of infertile patients in general.  
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Why Is Hysteroscopy Done?

Hysteroscopy can help in determining the basis behind heavy periods, pelvic pain, postmenopausal bleeding, uncommon vaginal bleeding, recurrent miscarriages, and inability to carry a pregnancy, all of which indicate some uterine cause. This examination can help in identifying and at the same time also treat several such conditions that affect the pregnancy outcomes in females. Some likely reasons why hysteroscopy gets done are: 

1. Endometrial Polyps:

 Polyps can distort the endometrial cavity and lead to an adverse impact on the endometrial receptivity, hence increasing the implantation failure rate. The removal of polyps via hysteroscope before IUI or IVF can increase pregnancy rates. 

2. Biopsy:

 A hysteroscopic biopsy aids doctors to diagnose chronic infections that impact female fertility. Around 15% of IVF patients have chronic infections. Many researchers suggest that once chronic infections get treated, the pregnancy rates after IVF rise substantially. 

3. Asherman’s Syndrome:

Hysteroscopy is also used to remove intrauterine adhesions (scarring) caused by infection or previous surgeries. 

4. Intra-Uterine Fibroids:

Fibroids refer to non-cancerous muscle growths within the uterus walls, which can be diagnosed using hysteroscopy in cases where these grow into the cavity. After the condition gets diagnosed, the doctor removes the tissue from the walls through hysteroscopy. 

5. Uterine Septum:

With hysteroscopy, doctors can evaluate if a woman has an abnormally shaped uterus or uterine septum. Both abnormally shaped uterus and uterine septum can prevent pregnancy in a woman. However, it is possible to correct them surgically.

6. Before ART:

Hysteroscopy has also been used to improve the chances of pregnancy in succeeding IVF cycles for women who have had one or numerous missed IVF cycles. For those that have a normal hysterosalpingogram before their IVF cycle, this allows for the diagnosis and treatment of intrauterine pathology. 


Hysteroscopy for IVF

A hysteroscopy for IVF is advised not always, but it’s the most viable way to check whether the uterus is healthy and ready to carry a baby or not. A hysteroscopy can witness things that ultrasound cannot. To understand the infertility issues of a patient, TVS (transvaginal sonography) & HSG (hysterosalpingography) are the most widely used procedures. But as compared to an HSG, hysteroscopy can give much more information and can be therapeutic at the same time. 
However, hysteroscopy is believed to be the gold standard for the diagnosis of intrauterine lesions. Hysteroscopy provides very accurate guidance about the form and size of the uterine cavity and an idea about the width and surface of the endometrium. 
Issues with the uterus or genetics are usually the reasons behind failed IVF attempts. In the last few years, hysteroscopy was performed routinely on women who had failed IVF cycles to check for any scar tissues and uterine growths. For women who have faced frequent miscarriages or implantation issues, then hysteroscopy is a helpful procedure. 
Read: Symptoms of Infertility in Females 
The advent of TVS and sono-salphigography (SSG) has made it possible to not conduct diagnostic hysteroscopy in every IVF patient. Only those patients who receive abnormal findings in their TVS or SSG need to be treated using operative hysteroscopy. 
Other non-invasive methods of assessing the uterine cavity include hysterosonography (HSN), which involves infusing a small amount of saltwater into the uterus and performing an ultrasound to assess the uterus. Here, in this case, too, hysteroscopy is reserved for cases when there is an abnormality in the HSN. 
A majority of the doctors truly think that an initial non-invasive procedure should be performed first. If an anomaly is noticed, hysteroscopy is suggested. If everything is normal, hysteroscopy is usually not necessary. 
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How is Hysteroscopy Performed?

  • After injecting general anaesthesia, the doctor will insert a small Hysteroscope through the cervix into the uterus, entering the uterus and obtaining the visual representation of the uterine cavity with a salt solution for distension. 
  • The doctor analyses the shape of the uterus, the openings to the fallopian tubes, and the uterine lining to find the signs of intrauterine pathologies, such as fibroids or polyps. 
  • Following the completion of the uterine cavity inspection, various instruments could be implanted based on the diagnosed issue. The hysteroscope is used to extract uterine fibroids, polyps, adhesions, and the septum. 

Hysteroscopy is a preferred and suitable technique for evaluating female infertility. The recovery time is short, and most hysteroscopy patients are discharged on the same day.

Read: Hysteroscopy vs Laparoscopy 

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