ROLE OF HYSTEROSCOPY IN GYNECOLOGY AND INFERTILITY MANAGEMENT
Hysteroscopy is a valuable diagnostic and therapeutic modality in the management of infertility. The advent of hysteroscopy in the field of gynecology has revolutionized the diagnosis and treatment of intrauterine disease. Recent technological advancement had made hysteroscopy efficacious, cost effective and safe. Hysteroscopy, is considered the gold standard for diagnosis of intrauterine lesions.
When is hysteroscopy recommended during fertility treatment?
Hysteroscopy is recommended for futher investigation of the uterus, if there is:
- Abnormal hysterosalpingogram
- Abnormal uterine bleeding
- Suspected intrauterine pathology
- Uterine anomalies
- Unexplained infertility
- Recurrent Pregnancy Loss.
Hysteroscopy is also used in the following:
- Removal of adhesions which have occurred because of infection or from past surgery
- Diagnosis of etiology of repeated miscarriage when a woman has more than two miscarriages in a row
- Location of anintrauterine device (IUD)
- To perform sterilization in which the hysteroscope is used to place small implants into a woman's fallopian tubes as a permanent form of birth control
Hysteroscopic removal of polyps in women with unexplained infertility may increase their chances of becoming pregnant
Types of Hysteroscopy
Diagnostic hysteroscopy is used to diagnose problems of the uterus. Diagnostic hysteroscopy is also used to confirm results of other tests, such as hysterosalpingography (HSG). HSG is an X-ray dye test used to check the uterus and fallopian tubes. Diagnostic hysteroscopy can often be done in an office setting.
Additionally, hysteroscopy can be used with other procedures, such as Laparoscopy or prior to procedures such as dilation and curettage. In laparoscopy, your doctor will insert an endoscope (a slender tube fitted with a fiber optic camera) into your abdomen to view the outside of your uterus, ovaries and fallopian tubes. The endoscope is inserted through an incision made through or below your navel.OPERATIVE HYSTEROSCOPY
Operative hysteroscopy is used to correct an abnormal condition that has been detected during diagnostic hysteroscopy. If an abnormal condition was detected during the diagnostic hysteroscopy, an operative hysteroscopy can be performed at the same time, avoiding the need for a second surgery. During operative hysteroscopy, small instruments used to correct the condition are inserted through the hysteroscope.When is operative hysteroscopy used?
Your doctor may perform hysteroscopy to correct the following uterine conditions:
- Polyps and fibroids: Hysteroscopy is used to remove these non-cancerous growths found in the uterus.
- Adhesions: Also known as Asherman's Syndrome, uterine adhesions are bands of scar tissue that can form in the uterus and may lead to changes in menstrual flow as well as infertility. Hysteroscopy can help your doctor locate and remove the adhesions.
- Septums: Hysteroscopy can help determine whether you have a uterine septum, a malformation (defect) of the uterus that is present from birth.
- Abnormal bleeding: Hysteroscopy can help identify the cause of heavy or lengthy menstrual flow, as well as bleeding between periods or after menopause. Endometrial ablation is one procedure in which the hysteroscope, along with other instruments, is used to destroy the uterine lining in order to treat some causes of heavy bleeding.
Hysteroscopy is performed approximately half the time for the diagnosis of infertility. Hysteroscopy should be performed after careful history and physical examination as well as utilization of adjunctive preoperative tests. Prior to the procedure, a medication may be given to help you relax and a general or local anesthetic may be used to block the pain. If general anesthesia is given, you will not be awake during the procedure. It is generally best performed in the post-menstrual proliferative phase. It will be scheduled when you are not having your menstrual period. Different locations for hysteroscopy include the office, surgery center, or hospital operating room.
Hysteroscopy involves the placement of a small hysteroscope (typically 4 mm) which is a thin, lighted telescope-like device. It is inserted through yourvaginainto your uterus. The hysteroscope transmits the image of your uterus onto a screen. Other instruments are used along with the hysteroscope for treatment. No incisions are required for hysteroscopy.
To make the procedure easier, your cervix may be dilated (open) before your hysteroscopy. You may be given medication that is inserted into the cervix, or special dilators may be used. Aspeculumis first inserted into the vagina andhysteroscope is then inserted and gently moved through the cervix into your uterus. Carbon dioxide gas or a fluid, such as saline (salt water), will be put through the hysteroscope into your uterus to expand it. The gas or fluid helps your doctor view the lining more clearly. The amount of fluid used is carefully checked throughout the procedure. Your health care professional can view the lining of your uterus and the openings of the fallopian tubes by looking through the hysteroscope. If abiopsyor other procedure is done, small tools will be passed through the hysteroscope.
Abnormalities inside the uterine cavity such as scar tissue (from prior infection or pregnancy), fibroids, polyps or uterine malformations (such as uterine septum) can be both evaluated and treated surgically at the time of hysteroscopy.RECOVERY AND OUTLOOK
The recovery from a hysteroscopy generally takes only 24-48 hours, since no incision is required. The risks associated with hysteroscopy are very minimal, and include very low chances of bleeding, infection, or uterine perforation.You should be able to go home shortly after the procedure. If you had general anesthesia, you may need to wait until its effects have worn off.It is normal to have some mild cramping or a little bloody discharge for a few days after the procedure. You may be given medication to help ease the pain. If you have a fever, chills, or heavy bleeding, call your doctor right away.
Complications of hysteroscopy are reported in 1 to 3% of cases. These include cervical laceration, uterine perforation, bleeding, reactions to the distention media, or anesthesia. Potential long-term complications include femoral injury resulting in intrauterine scarring or tubal obstruction, as well as injury to contiguous organs.CONTRAINDICATIONS
Absolute contraindication - pelvic infection or endometrial cancer
Relative contraindication - Pregnancy, excessive bleeding, cardiovascular disease, severe vaginitis.