Hysteroscopy for Infertility: Purpose, Procedure and Recovery - Dr. Suhasini Inamdar

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Hysteroscopy basically means visualisation of the uterine cavity and why we need to do when we have a patient with infertility this is the major investigative and curative procedure when we do in girls who have some problem in conceiving. So this is basically done basically post menstrual. So we call the ladies say about 5th 6th, or 8th day and this is done under short general anesthesia. In case we have to change from diagnostic to curative procedure it has to be shifted accuratively and the girl comes in the morning, gets admitted and in the evening she is discharged, come to the basic thing why is it necessary. We have to understand whether there is any problem with the cavity of the uterus, are there are any septums which is a congenital defect. So if there is a septum we have to deal with it. If it is a complete septum or incomplete septum we have to remove this because the embryo cannot go and sit on the septum and that is how the pregnancy is not happening. So in such cases the septum is removed. If there is a polyp it will behave like an IUCD and it will not let the embryo go and sit inside so we have to deal with this to remove this which again we can do hysteroscopically and then there are other things like submucus fibroids which again can be removed and that can make the cavity very receptive for the embryo to go and sit at the same time we see how the cervical canal is. If there is any cervical growth or polyp there. If that is so then we take care of that too. If we are taking care of some procedures which we normally do for infertility of long duration like IUI’s or IVF, we need to understand the direction and the opening of the canal also because when we catheterise and we put catheters for the IUI’s embryo transfer, it should be easily negotiable, there should not be any obstruction to the catheter, that also we have to see into this. Again we measure the length of the uterus or the cervix so that when we are doing the transfers, when we are doing the IUI we know exactly where to put the embryo or where to put the semen sample. Another thing what we see in hysteroscopy is the ostia or the end of the tube which is opening in the uterus. We need to see the ostea to see whether the tubes are patent. If the hysteroscopy is combined with laparoscopy then it is very easy to understand and open the tubes that are blocked. But hysteroscopy per se also gives us good information about the patency of the tubes. So these are the reason why we do hysteroscopy for the couples who come with infertility and if you think about the risk factors, then they are as good as any procedure by and large hysteroscopy is very safe, very informative for us to plan the future treatment for couples who come with infertility. Hysteroscopy gives us a fair idea about Asherman's syndrome also because of the previous DNC’s or some disease process which is happening inside the uterus, the walls of the uterus gets adherent to each other and they don’t leave any cavity where the embryo can go and sit. So when we are doing hysteroscopy we understand if there are adhesions we do away those adhesions hysteroscopically only.