What is hysteroscopy? | Hysteroscopy for Infertility

Hysteroscopy is one of the most widely used methods for examining the health of the uterus. Some uterine disorders can cause infertility problems that, if diagnosed and treated early, can help with a healthy pregnancy. Hysteroscopy is a minimally invasive surgical procedure that is used to diagnose or treat uterine problems such as abnormal bleeding, adhesions, polyps, etc. In hysteroscopy, a narrow instrument called a hysteroscope, which is similar to a telescope, is inserted into the uterus through the vagina. At the end of the hysteroscope are a camera and a small lamp. This camera sends images of the uterus to the device monitor so that a specialist doctor can examine the inside of the uterus.

Types of hysteroscopy

Hysteroscopy is an effective way to diagnose and correct uterine disorders. The use of hysteroscopy allows the specialist to identify uterine problems and perform the necessary treatments. Hysteroscopy can be performed in two types: diagnostic and therapeutic:

Diagnostic hysteroscopy is used to examine the condition of the uterus. This type of hysteroscopy helps diagnose abnormal uterine conditions such as myomas, scars, adhesions, polyps, and congenital uterine disorders. In addition, diagnostic hysteroscopy is widely used to identify the causes of infertility, recurrent miscarriage, abnormal uterine bleeding, and diagnostic uterine cancer. Diagnostic hysteroscopy is also used to confirm the results of other tests, such as a color photograph of the uterus (HSG).

Therapeutic hysteroscopy can treat many of the disorders and lesions identified during diagnostic hysteroscopy. The therapeutic hysteroscopy process is similar to diagnostic hysteroscopy, except that the hysteroscopy is more widely used to allow surgical instruments such as lasers, scissors, electrodes, and a sampler to be inserted into the uterus through the hysteroscopy.

Hysteroscopy can be used to remove myomas, scars, and polyps in the uterus. In addition, some congenital abnormalities of the uterus, such as the uterine septum (intrauterine septum), can be corrected by hysteroscopy. When the cause of severe uterine bleeding is an overgrowth of the endometrium (inner wall of the uterus), hysteroscopy treatment can be used to remove the endometrium to prevent heavy bleeding. In some cases, hysteroscopy is performed at the same time as diagnostic laparoscopy so that a specialist doctor can see inside and outside the uterus at the same time.

How is the hysteroscopy performed?

In this method, the person first puts on special clothes and lies down on the gynecological examination bed. General anesthesia or local anesthesia is used before the surgery to prevent the sensation of pain. After anesthesia, the doctor uses a special tool called a speculum to hold the cervix open for the surgical instrument to pass through. Then, the specialist gently inserts the hysteroscope into the uterus through the vagina. To make the inside of the uterus more clearly visible, carbon dioxide gas or a special solution is injected into the uterus through a hysteroscopy.

The doctor uses the camera at the end of the hysteroscope to view the uterus, cervix, and fallopian tubes. With a complete examination of the uterus and fallopian tubes, the specialist can diagnose possible disorders such as uterine adhesions, fibroids, myomas, and uterine polyps. If necessary, it is also possible to sample or remove benign uterine glands such as myomas, fibroids, polyps, or uterine adhesions through the hysteroscopy.

When is the best time to do hysteroscopy?

The best time to do a hysteroscopy is a few days to a week after menstruation. Because at this time the doctor has the best vision for the intrauterine examination. Hysteroscopic surgery can take 5 to 30 minutes, depending on the cause.

What are the applications of hysteroscopy?

Hysteroscopy is used to diagnose and treat uterine abnormalities. These abnormalities can cause many problems for women and even lead to infertility problems. One of the most common applications of hysteroscopy is to find the cause of abnormal uterine bleeding. Abnormal uterine bleeding may be due to the benign growth of the endometrium (inner lining of the uterus), such as a fibroid or polyp. Hysteroscopy is generally used in the following cases:

• Detection and treatment of uterine adhesions: Intrauterine adhesions usually occur due to chronic pelvic infections, miscarriage, severe postpartum hemorrhage, repeated IVF, and so on. Hysteroscopy can be used to detect these adhesions. In addition, adhesions can be removed during diagnostic surgery.
• Diagnosis and treatment of uterine polyps and fibroids: If a vaginal ultrasound shows a polyp or fibroid in the wall of the uterus, the presence of a polyp and fibroid can be confirmed with hysteroscopy and removal can be performed. During the use of infertility treatment methods, polyps sometimes form in the uterine wall due to the use of hormonal drugs. In these cases, the polyps must be removed by the hysteroscopy from the uterus before the fetus can be transferred to the uterus.

• Diagnosis of the cause of abnormal uterine bleeding: Hysteroscopy can help diagnose the cause of heavy or prolonged menstrual bleeding, abnormal bleeding between periods, or abnormal bleeding after menopause.

• Diagnosis and treatment of uterine abnormalities: Hysteroscopy can be used to diagnose congenital abnormalities of the uterus, such as the septum in the uterus, the horned uterus, and so on. The uterine septum is a structural disorder of the uterus that divides the uterine cavity into two parts. The uterine septum increases abortion, preterm delivery, premature placental abruption, and IVF failure. In IVF candidates, if a septum is seen on a color photograph of the uterus, hysteroscopy is recommended to remove the septum.

• Identify the cause of recurrent miscarriages: One of the applications of hysteroscopy is to investigate and identify the cause of recurrent miscarriages.

• Performing contraceptive methods: Hysteroscopy can be used to place permanent contraceptive implants in the fallopian tubes.

What care should be taken after hysteroscopy?

Hysteroscopy is an outpatient surgery, and many women return to their normal daily activities after the hysteroscopy. If general anesthesia is used for hysteroscopy, there may be a need for a few days of rest.

After hysteroscopy, uterine contractions may occur similar to menstrual contractions. Spotting or abnormal vaginal bleeding is normal for a few days after hysteroscopy, but if the bleeding and pain are severe, you need to tell your doctor.

To reduce the risk of infection, it is best to abstain from sexual intercourse for up to 2 weeks after hysteroscopy. If your doctor prescribes an antibiotic, you should take it seriously. See your doctor if you have symptoms of fever and abnormal vaginal discharge.

 What are the advantages of hysteroscopy?

In hysteroscopy, there is no need to make an incision in the body. Therefore, hysteroscopy has many advantages over open surgery. Reducing pain, recovery time, the likelihood of adhesions, and the risk of infection are the most important benefits of hysteroscopy compared to open surgery.

In the past, major surgeries were needed to diagnose and correct uterine malformations. But nowadays, many uterine disorders are diagnosed and treated on an outpatient basis using hysteroscopy and laparoscopy. Hysteroscopy can be used to diagnose a wide range of uterine problems. In addition, during the hysteroscopy at the same time as the diagnosis; it is possible to treat some abnormalities and diseases of the uterus.

What are the complications of hysteroscopy?

Hysteroscopy is a very low-risk procedure, but like any other surgical procedure, it can have complications. These complications are more common in therapeutic hysteroscopy than in diagnostic hysteroscopy. Some hysteroscopy complications are:

• Bleeding during and after hysteroscopy: This complication usually occurs in therapeutic hysteroscopy and under general anesthesia. This complication is usually controlled with medication.
• Uterine infection: This complication may be manifested by foul-smelling vaginal discharge, fever, and heavy bleeding. The infection is usually treated with antibiotics.
• Injury to the uterus and cervix: This is a rare complication and depends on the skill of the surgeon.
• Injury to adjacent organs: This complication is also rare. If hysteroscopy is performed by an inexperienced surgeon, nearby organs such as the ovaries and bladder may be damaged.

Application of hysteroscopy before IVF

It is important to ensure the health of the uterus and fallopian tubes before IVF. Studies show that removing polyps, myomas, and uterine adhesions before starting infertility treatment doubles the chances of successful IVF. Therefore, some infertility treatment centers perform hysteroscopy one month before the start of the IVF cycle to check the health of the uterus and eliminate possible problems.

Another important factor in the success of IVF is implantation and the ability of the embryo to accept the uterus. By scratching the endometrium, inflammatory cells and growth factors accumulate at the wound site. These cells can increase the chances of the embryo implanting. Therefore, hysteroscopy is also used to scratch the endometrium before IVF. Endometrial scratches are most commonly used in women who have experienced one or more unsuccessful IVF cycles, despite the good quality of their embryos.

Hysteroscopy in Iran

Hysteroscopic surgery services in Iran are provided in the best infertility treatment centers in order to diagnose and treat uterine problems. Hysteroscopy in Iran is performed by the best Iranian fertility doctors and specialists and uses up-to-date equipment with great precision and elegance so that it does not have any complications. The cost of hysteroscopy procedure is between 1000 to 2000 dollars in Iran. For more information about hysteroscopy in Iran and to get advice from specialist doctors, you can contact us.