All About Hysteroscopy—When & Why Hysteroscopy is Performed?
What is Hysteroscopy?
How Does it Differ from Laparoscopy?
When & Why Should Hysteroscopy be Performed?
Diagnostic and Operative Hysteroscopy
Role of Hysteroscopy in IVF
Postoperative Care
It is widely accepted that a complete infertility workup must include a uterine cavity evaluation. Uterine abnormalities, acquired or congenital, are implicated as one of the causes of female infertility. In fact, infertility associated with uterine abnormalities has been estimated to be one of the causal factors in 10-15% of couples seeking treatment. Furthermore, uterine cavity abnormalities have been found in 34-64% of infertile women.
The diagnosis of a woman’s internal pelvic structure could provide important information about some common gynecologic disorders and infertility. Problems that cannot be discovered by external physical examination might be discovered with the help of laparoscopy and hysteroscopy.
Hysteroscopy and laparoscopy are the two procedures that give a direct inspection of the pelvic organs and may be recommended as a part of your fertility care, depending on your particular situation.
Today, Hysteroscopy is coined as the gold standard for evaluating the uterine cavity because it has the unique advantage of combining a thorough procedure with great diagnostic accuracy.
The following information will help you understand what is hysteroscopy, when, why it is done, and what to expect before undergoing this procedure.
What is Hysteroscopy?
Hysteroscopy is a procedure used for visually examining the uterine cavity. It is carried out using a hysteroscope-a thin telescope-like instrument is inserted through the vagina and cervix, most importantly no cuts need to be made. A small camera and light are attached to the end of the telescope which provides the doctor a magnified view of the womb on a monitor. Hysteroscopy can be a part of both the diagnosis process or an operative procedure.
How Does it Differ from Laparoscopy?
Laparoscopy is a minimally invasive procedure contrarily skin incisions are not required for hysteroscopy. In laparoscopy, a small incision will be made in the umbilicus to make a small hole to access the abdominal cavity and the internal organs are visualized through a camera connected to the monitor. Simply put, laparoscopy gives an aerial view while hysteroscopy is looking at pelvic organs from inside.
When & Why Should Hysteroscopy be Performed?
A hysteroscopy is used to :
- Investigate problems like heavy periods, pelvic pain, abnormal bleeding, to identify the cause for recurrent miscarriages or any other difficulties that are not letting you get pregnant.
- Diagnose conditions such as polyps, fibroids (non-cancerous growths found in the uterus) adhesions (these are bands of scar tissue that form in the uterus that might lead to changes in menstrual flow also infertility), and septums (malformation or defects in the uterus).
- Treat problems & conditions like removing endometrial polyps, fibroids, intrauterine adhesions, and hysteroscopy help in identifying the cause of lengthy and heavy menstrual flow.
Diagnostic and Operative Hysteroscopy
Diagnostic Hysteroscopy
As a diagnostic tool, hysteroscopy is used to examine the uterine cavity and aids in diagnosing abnormal uterine conditions like polyps, fibroids protruding into the uterine cavity, scarring, congenital malformations, etc.
Additionally, it helps identify underlying causes of abnormal uterine bleeding and dysmenorrhea such as adhesions. Diagnostic hysteroscopy is also used to confirm the test results of pelvic ultrasounds and HSG-hysterosalpingography (an x-ray dye test to outline uterus & fallopian tubes). Sometimes, it can be used along with other procedures such as laparoscopy or before procedures like D&C dilation and curettage.
The first step of this procedure involves slightly stretching the canal of the cervix using a series of dilators to increase the size of the opening temporarily. Then the hysteroscope (telescope-like instrument) is inserted into the uterus. Later fluid like saline or carbon dioxide gas is injected into the uterus to expand the cavity and enables the physician to view the internal structure. Diagnostic hysteroscopy is an outpatient procedure often done in an office setting.
Operative Hysteroscopy
Operative hysteroscopy can treat various abnormalities detected during diagnostic hysteroscopy or even on other imaging studies. If an abnormal condition was found while performing diagnostic hysteroscopy, an operative hysteroscopy could be performed at the same time to avoid the need for a second surgery.
A hysteroscope is a long, thin, and slender telescopic device used to view the inside of the uterus. It is not only used to diagnose abnormal uterine conditions but also to treat them. Polyps, fibroids, scar tissues, and adhesions can be removed with the operative hysteroscope. Some structural abnormalities like septum can be corrected and cannulation for a proximal tubal block can be done as well.
Role of Hysteroscopy in IVF
Hysteroscopy is a very important procedure that is recommended to be done before IVF treatment to assess the uterine cavity. Extra growths in the uterus like polyps, fibroids need removal and uterine abnormalities need to be corrected otherwise it may result in IVF failure.
Despite progressing improvement in the area of IVF, the maximal implantation rate per embryo transfer doesn’t usually exceed 30%. Even if an egg retrieval is done properly and fertilization occurs successfully, there is an unexplained drop between embryo transfer & the occurrence of pregnancy.
In around 11-45% of cases of IVF failure, there have been problems found inside the uterine cavity. Thus, hysteroscopy makes sense to solve this problem and maximize IVF success rates.
Postoperative Care
Following hysteroscopy, some vaginal discharge, mild bleeding, and cramping may be experienced for a few days, which are common. Most physical activities can be resumed within one or two days. Some antibiotics may be prescribed after surgery by the physician and other concerns will be explained to you.
Hysteroscopy allows complete, accurate identification of uterine abnormalities and treats them effectively. The information derived from the hysteroscopy aids the physician or fertility specialist to advocate appropriate treatments.
Dr. Vyjayathi is a highly qualified and experienced fertility specialist in Hyderabad who has achieved excellence in treating fertility issues by providing advanced fertility treatments & patient care. She is also an expert surgeon, specialized in laparoscopy, hysteroscopy, and minimally invasive surgeries.
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