Author: Dr. Shruti N ManeQualification – M.B.B.S, M.S (OBG), PG Diploma in ART AND Reproductive Medicine
Hysteroscopy is the exam of the inside of the cervix and uterus using a thin, lighted, flexible tube called a hysteroscope that a surgeon inserts through your vagina. Hysteroscopy can be a part of diagnostic as well as operative process to identify structural abnormalities of your uterus. Diagnostic and operative hysteroscopy can be performed at the same time by your surgeon.
Should hysteroscopy be done routinely in all cases of infertility?
How does hysteroscopy help in an IVF/ICSI treatment?
- In IVF and ICSI treatment a large drop is present in between embryo transfer and occurrence of pregnancy.
- Many couples fail to achieve a successful pregnancy even after transfer of good quality embryos.
- 11% – 45% of infertile females have shown an evidence of miniature uterine abnormalities even after a normal transvaginal ultrasonography or hysterosalpingography
- Hysteroscopy is the definitive method for the diagnosis and treatment (correction)of intrauterine pathologies.
How does hysteroscopy help in an IVF/ICSI treatment?
- Identifying uterine pathologies : Hysteroscopy can help identify uterine abnormalities or problems within the uterus like presence of an uterine septum, submucosal fibroids, endometrial polyps , and intrauterine adhesions or scar tissue. These abnormalities can hinder the path of ascending sperms prevent the implantation of the embryo, hinder the growth of a developing fetus. They can also lead to miscarriages, repeated pregnancy losses, preterm births, repeated IVF failures. Correction of these abnormalities before IVF treatment increases the pregnancy rate and live birth rates.
- Diagnosing infections of the uterine lining: A common hysteroscopic finding in chronic endometritis is presence of a thickened edematous endometrium. Chronic endometritis impairs endometrial receptivity and hence may lead to failure of implantation of the embryo to the endometrium. 30% of patients with repeated IVF failures have chronic endometritis as it lowers implantation rates by 11%.
- Previous Failed IVF/ICSI treatments: Hysteroscopy can be beneficial beyond just treating the uterine abnormalities. Irrigation of saline during hysteroscopy may have a positive impact on implantation and pregnancy rates as the saline used during hysteroscopy mechanically washes of anti-adhesive glycoproteins on endometrial surface and improves endometrial receptivity.
- Prepare uterus before embryo transfer: In few cases with dysmorphic uteri (i.e. T-shaped uterus/Infantile uterus) the uterine cavity is narrow and small compared to a normal uterine cavity, such small or narrow cavities may cause miscarriages, preterm deliveries, implantation failure, even after a positive pregnancy and failure to reach the goal of healthy term pregnancy .
A few benefits of hysteroscopy Include:
- Diagnosis of uterine abnormalities and pathologies missed on transvaginal ultrasound or hysterosalpingography mostly in cases of unexplained infertility, repeated IVF failures, repeated pregnancy losses.
- Restoration of a normal uterine cavity: After septal resection or metroplasty, to restore the uterine cavity to its normal capacity and architecture making it capable for carrying a healthy pregnancy.
- To verify whether the uterine architecture is normal: A second look hysteroscopy may be required in few cases after a primary operative hysteroscopic septal resection or metroplasty to confirm whether the cavity is healthy before an embryo transfer, to carry a pregnancy.
- Assessment of the endometrial development in response to endogenous ovarian steroid production is normal prior permitting the patient to conceive through an IVF treatment.
- Easy embryo transfer: It also helps in an easier embryo transfer and more accurate embryo placement.
- Improved Endometrial Receptivity: It also augments the endometrial receptivity secondary to an endometrial stimulation (due to local endometrial injury).
Hysteroscopy plays a major role in women undergoing IVF/ICSI treatment. It has both diagnostic and therapeutic utilities. Intracavitary lesions such as polyps and fibroids distort the endometrium but cause inflammatory and immunological reactions that may affect embryo implantation. Evidence suggests that a Hysteroscopy prior to an IVF cycle improves pregnancy rates. Hysteroscopy in cases of failed IVF cycles and repeated pregnancy losses is a principle key for a positive outcome. The decision to undergo the procedure will depend on the individual circumstances of the patient and the recommendations of their fertility expert.
Why might I need a hysteroscopy?
- Abnormal PAP results: Incase your pap results shows abnormal findings a diagnostic hysteroscopy can be performed to evaluate the inside of your cervix and uterus combined with a tissue biopsy.
- Abnormal Uterine bleeding: Hysteroscopy can be performed in such cases to identify the cause of abnormal bleeding and can be therapeutic as well at the same time.
- Infertility: Mostly in cases of unexplained infertility it can be combined with laparoscopy to evaluate other pelvic and intrauterine causes for infertility.
- Diagnosis of uterine pathology: Hysteroscopy helps in examining the uterine cavity and identifying its abnormalities like polyps, fibroids, intrauterine adhesions which can be operated in the same set-up.
- Evaluation in cases of repeated pregnancy losses and repeated IVF failures: In such cases hysteroscopy can help in diagnosing the uterine factors responsible for failure of implantation and pregnancy losses and correction of the same.
- Endometrial biopsy: In certain specialized tests for evaluating the endometrial receptivity (Endometrial receptivity array), hysteroscopy can be combined with the test prior to an embryo transfer.
- Restoration of uterine cavity: To restore the normal uterine architecture an operative hysteroscopy can help for removal of a uterine septum or incases of dysmorphic uteri (T-shaped /infantile uterus), uterus with small or narrow cavities.
What are risks for a hysteroscopy?
Hysteroscopy is considered a safe procedure however with any surgery complications can occur, with hysteroscopy complications occur in less than 1% of cases and may include:
- Heavy Bleeding
- Pelvic Inflammatory disease
- Uterine Perforation:
- Damage or trauma to the cervix, bowel and bladder
- Complications from fluid or gas used to expand the uterus
- Anesthetic risks: Allergy or reaction to anesthesia
There may be other risks involved specific to your condition, make sure you discuss them with your doctor.
Certain things may interfere with hysteroscopy which includes
- Inflamed cervix
- Excessive Vaginal discharge
- Active Vaginal infection
- Pelvic Inflammatory disease
- Bloated bladder
Overall, the risks of hysteroscopy are generally low. It is important to discuss any concerns or questions with a healthcare provider before the procedure. You can always chat with our doctors at Motherhood Fertility & IVF Centre and they will take you through all the risk factors associated with the process.
What is cost of a hysteroscopy in INDIA?
The cost of a hysteroscopy in India can vary depending on several factors, including the type of procedure being performed, the location of the facility, and the individual’s specific healthcare needs. On average, the cost of a hysteroscopy in India ranges from around INR 5,000 to INR 15,000 (approximately $68 to $204). However, this is just an estimate and the actual cost may be higher or lower depending on the specific circumstances.
It is important to note that the cost of a hysteroscopy may not be covered by insurance, and it is a good idea to check with your insurance provider to see what is covered under your policy. Additionally, it is advisable to discuss the cost of the procedure with your healthcare provider and ask about any payment plans or financing options that may be available.
In conclusion, hysteroscopy is a valuable tool that can be used to identify and correct problems within the uterus before IVF treatment. By ensuring that the uterus is healthy and ready for pregnancy, the chances of a successful pregnancy during IVF treatment may be improved. To know more about the cost of hysteroscopy, benefits and risks, you can call Motherhood Fertility & IVF Centre by calling 08067238900 or book an appointment with us.
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