Hysteroscopy at a glance
- Hysteroscopy is a minimally invasive procedure that uses a thin, flexible telescope-like instrument, known as a hysteroscope, to examine the uterine cavity.
- Hysteroscopic evaluation can be used to diagnose conditions that contribute to female infertility and recurrent miscarriage.
- Minimally invasive surgeries, like the removal of uterine fibroids or polyps, can also be performed via hysteroscopy.
- Hysteroscopy has been shown to increase in vitro fertilization (IVF) success rates.
What is hysteroscopy?
Hysteroscopy is a minimally invasive procedure that diagnoses and corrects conditions of the uterus. During the procedure the doctor inserts a hysteroscope (a lighted, telescope-like instrument with a camera on one end) through the vagina to examine the cervix and uterine cavity. Small instruments can be passed through the hysteroscope to perform biopsies or remove abnormalities from the uterus that are detected.
A hysteroscopy doesn’t need an incision. A diagnostic hysteroscopy can take as few as 30 minutes, but if the physician needs to perform a procedure, for example removing a fibroid, the hysteroscopy may take longer. A diagnostic hysteroscopy can often be performed in the comfort and convenience of a medical office, but more complex procedures are best performed in a hospital setting.
Who needs a hysteroscopy?
A critical part of the IVF process is an accurate assessment of the uterus – the best embryo, made from the best egg and sperm will not implant for pregnancy if there are problems with the uterus. This procedure offers women holistic insight into the health of their reproductive system and their fertility. Studies have shown that hysteroscopic evaluation identified disease in the uterus in 38% of patients. Hysteroscopy effectively identifies abnormalities in the uterus and can increase the likelihood of IVF success.
Clear results. Clear explanations. The ARMS Difference.
Before we place an embryo into the woman’s uterus at ARMS, we evaluate her uterine cavity through hysteroscopy. This helps us make an accurate diagnosis and recommend the best treatment plan for the patient’s unique situation.
Using hysteroscopy to identify female infertility
Hysteroscopy is often used by physicians to determine the source of heavy or irregular bleeding, which can indicate ovulation problems. Hysteroscopy identifies and treats a number of conditions that affect a woman’s ability to conceive and carry a pregnancy. Some potential uses of hysteroscopy include:
- Assess and remove uterine fibroids, polyps or scar tissue.
- Evaluate the structure of the uterus, identifying uterine septum (tissue that divides the uterine cavity) or other abnormalities.
- Perform a biopsy.
Commonly evaluated problems include the identification of birth defects in the woman (a uterine septum for example), tumors or scar tissue within the uterus, and chronic infections. Other, increasingly rare, problems found during uterine evaluation include the presence of a chronic infection, precancerous tissue or inflammation from endometriosis.
Diagnosing uterine abnormalities
Polyps and uterine fibroids are a common factor in infertility. Polyps are abnormal tissue growths that occur in the inner lining of the uterus (endometrium) that can be diagnosed using hysteroscopy. Fibroids are noncancerous muscle growths within the walls of the uterus and can also be diagnosed with a hysteroscopy guided biopsy.
After diagnosing either condition, the doctor will remove the tissue via hysteroscopy. Fertility treatments including IVF are often more successful because this makes the uterus more receptive to implantation.
Hysteroscopic evaluation can also identify whether a woman has an abnormally shaped uterus or a uterine septum. Both conditions can prevent a woman from becoming pregnant or from carrying a pregnancy to term. They can be corrected surgically.
Diagnosing a chronic infection
Hysteroscopy guided biopsy is an effective way to diagnose chronic infections that affect female fertility. Chronic infections are present in approximately 15% of IVF patients. And in patients with recurrent implantation failure after IVF it’s estimated that as many as 42% of patients have a chronic infection. Research shows that once a chronic infection has been treated, pregnancy rates after IVF treatment double.
It’s estimated that 1 in 10 women have endometriosis, and nearly half of patients who have unexplained infertility are found to have endometriosis. Endometriosis can cause inflammation of the lining of the uterus and be a cause of implantation failure.
Physicians can identify endometriosis by testing endometrial tissue sampled via hysteroscopy guided biopsy for specific markers. In one study, 88 percent of patients with unexplained infertility tested positive for the BCL-6 marker for endometriosis. Women with that marker had an IVF pregnancy rate of only 17.3% compared with the 64.7% pregnancy rate for women without the same marker. The same study found that treatment of endometriosis before an embryo transfer can increase implantation and pregnancy rates.
Endometrial sampling for the endometriosis marker BCL-6 for the purposes of improving IVF success has been shown to be a less invasive and accurate way to diagnose endometriosis than other more invasive surgical procedures, like laparoscopy.
How does hysteroscopy compare with other procedures?
Hysteroscopy is the gold standard for evaluating the health of the uterus. It has been found to be more accurate at identifying and diagnosing many conditions that affect infertility than other methods. Hysterosalpingogram (HSG) and sonohysterogram, often referred to as a saline infusion sonography (SIS), though often considered alternatives to hysteroscopy, are less accurate for diagnosing certain conditions.
HSG testing is limited in how much information it can provide about a woman’s reproductive health. HSG testing uses an injectable dye and X-ray technology to examine the uterine cavity and the fallopian tubes’ connection to the uterus. HSG testing, however, cannot evaluate the full length of the fallopian tube (the tube that connects the ovaries to the uterus), limiting the diagnosis of fallopian tube irregularities to certain conditions and blockages.
HSG testing can effectively diagnose large birth defects and tumors, but often cannot be used to diagnose smaller tumors or scars in the uterus. At ARMS we often will perform HSG testing and a hysteroscopy prior to conducting treatment.
During SIS testing, the provider injects a saline solution into the uterus while performing an ultrasound to examine the endometrium for scarring, polyps or changes in thickness. SIS can effectively diagnose birth defects and tumors within the uterus, but it is less effective than hysteroscopy for the other findings.
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