Infertility refers to the biological inability of a couple to conceive after having regular and unprotected sex for 6-12 months. It can be because of male, female or both.
Infertility & Hysteroscopy
Hysteroscopy is a valuable diagnostic and therapeutic modality in the diagnosis & management of infertility in females. It involves the insertion of a narrow telescope-like instrument through the vagina and cervix into the cavity of the uterus (endometrial cavity). It not only offers the opportunity to visualize the intrauterine structures and provide diagnosis, but can also offer its therapeutic capabilities for conditions that may otherwise require a hysterotomy and, obviously, a laparotomy [open surgery]. The surgeon can view the pathology of the uterine cavity and treat it in the same sitting.
Indications for Diagnostic & Operative Hysteroscopy in Infertility
The main indication for hysteroscopy is infertile patient with an abnormal or ambiguous hysterogram. It is also a therapeutic method in many conditions that may affect fertility.
- Abnormal hysterogram
- Abnormal uterine bleeding
- Endometrial polyps
- Sub mucous and pedunculated myomas
- Intrauterine adhesions
- Uterine septa
- Uterine anomalies
- Tubal cornual occlusions
- Misplaced or embedded foreign bodies
- Other congenital anomalies and evaluation of endocervical anatomy
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The procedure uses a thin viewing tool called a hysteroscope. The hysteroscope has a light and camera attached to it so that the surgeon can view the anatomy on a video screen. The procedure is performed by gynaecologist in the operating room or doctor’s office with anaesthesia.
The procedure starts with the insertion of speculum into the vagina to open vaginal walls. Hysteroscope is inserted through the vagina and cervix into the cavity of the uterus (endometrial cavity). A gas or liquid will be put through the hysteroscope into the uterus to facilitate better view of the internal organs for the doctor. Doctor can view a magnified image of the uterus and uterine openings of the fallopian tubes for ay pathology on the video screen. Now the pathology is noted and in most of the cases, treated at the same time with the help of some other tools.
A hysteroscopy takes about 30 minutes, unless other procedures are being done.
Advantages of Hysteroscopy as compared to other diagnostic methods in the management of infertility
- Hysteroscopy facilitates direct visualization of uterine cavity
- It acts as a confirmation in the diagnosis and specification of intrauterine lesions
- Targeted biopsies and surgical therapy can be performed during hysteroscopy
- It gives very precise localization of abnormalities (polyps, myomas, malformations, adhesions, carcinoma and precursors)
- By diagnosing and treating the uterine abnormalities, hysteroscopy increases the chances of pregnancy in a woman