What is a hysteroscopy?
Hysteroscopy is a procedure that allows your doctor to look inside your uterus in order to diagnose and treat causes of abnormal bleeding. Hysteroscopy is done using a hysteroscope, a thin, lighted tube that is inserted into the vagina to examine the cervix and inside of the uterus. Hysteroscopy can be either diagnostic or operative.
Hysteroscopic Surgery for Fibroids is most often done on an “outpatient” basis under general anesthesia. It takes about 60 minutes to complete the procedure which is followed by a few hours of recovery time. Hysteroscopic myomectomy involves inserting a hysteroscope through the vagina and the cervix into the uterus. Hysteroscopes are thin enough to fit through the cervix with minimal or no dilation. Since the instruments are inserted through the cervix, no abdominal incisions are needed. The hysteroscope is a thin, telescope-like instrument that allows the doctor to view the fibroids. A resectoscope, which is a hysteroscope fitted with a wire loop that uses high-frequency electrical current to cut or coagulate tissue, is then inserted to remove the fibroids. The loop is placed around the fibroid, electrical energy passes through the loop and the fibroid is cut loose. The fibroid can then be removed through the vagina.
Is a hysteroscopy procedure painful?
During a hysteroscopy you may experience some discomfort relatable to the discomfort of period cramps. If you are awake, most people don’t feel any pain or discomfort, just some minimal cramping. Some women do experience pain, and at that time the procedure must be stopped.
Why is hysteroscopy done before IVF?
Unsuccessful IVF attempts usually are due to factors in the embryo, such as genetic problems, or issues with the woman’s uterus. In the past many fertility clinics routinely performed hysteroscopy on women who had failed IVF cycles, to look for uterine growths or scar tissue and remove them.
Hysteroscopy and IVF
Unsuccessful IVF attempts usually are due to factors in the embryo, such as genetic problems, or issues with the woman’s uterus. In the past many fertility clinics routinely performed hysteroscopy on women who had failed IVF cycles, to look for uterine growths or scar tissue and remove them. There are other, non-invasive methods of assessing the uterine cavity including hysterosonography (HSN) where a small amount of salt water is infused into the uterus and an ultrasound is performed to assess the uterus. Typically hysteroscopy is reserved for cases in which an abnormality has been identified on the HSN or HSG.
Several studies had seemed to find some benefit to hysteroscopy after an IVF cycle had failed. Some clinics routinely performed the procedure on every woman before beginning IVF treatment, believing that removing polyps or scar tissue before starting IVF gave the treatment a better chance to succeed.
However, a large randomized study conducted in Europe found no significant difference in IVF success rates between those who had hysteroscopy before IVF and those who did not. The study was reported at a meeting of the European Society of Human Reproduction and Embryology (ESHRE) in 2014. The 700 women in the trial had all had failed IVF cycles and were under age 38. They were randomly assigned to have a hysteroscopy or not to have the procedure. This is important because it reduces chances for bias in the study and makes the findings more reliable.
Live birth rate in the group who had hysteroscopy was 31 percent, while the group who did not have hysteroscopy had a live birth rate of 29 percent. In groups of that size, this is not a significant difference.
So what should you do? Should you have hysteroscopy before you begin IVF? Is it an added expense and invasive procedure for no good reason? Or is it good practice to give your IVF cycle the best chance of success? While there is no consensus of opinion or practice yet among reproductive endocrinologists, most agree that a preliminary non-invasive test such as HSN should be performed first. If an abnormality is identified, then hysteroscopy is indicated. If it is normal, then hysteroscopy is probably not necessary. It’s important to find a fertility doctor that you trust, and work together with him or her to find the best solution for you.