Diagnostic hysteroscopy prior to IVF
Diagnostic hysteroscopy is surely the most important gynecologic procedure to evaluate the endometrial cavity. The procedure is generally carried out as an outpatient procedure. With this method, it is possible to obtain clear information on the volume and shape of the uterine cavity. It also provides detailed information on the nature and thickness of the endometrium. HGS and 3D ultrasonography may be alternative to hysteroscopy. However, there are studies comparing hysteroscopy with HSG and indicating hysteroscopy to be superior.
The following are the questions to be considered for deciding the method to be used before IVF:
- Is it always necessary to investigate the uterine cavity before IVF?
- If it is a routine procedure, under what conditions should it be performed?
- Does the treatment of uterine abnormalities with hysteroscopy enhance the success of IVF?
Inherent or acquired pathologies in the uterus decrease the success of in vitro fertilization methods. According to studies, the incidence of endometrial and uterine anomalies can be up to 38% in repeated unsuccessful trials.
Therapeutic hysteroscopy before IVF
Many studies suggest that the chance for pregnancy increases after the treatment of uterine abnormalities. Although these findings emphasize that hysteroscopy should be routinely performed, it is not always applicable. Many medical centers argue that, depending on a patient’s individual risk factors, the incidence of uterine abnormalities is not so important that it can affect the success of implantation. These centers also believe that HGS or ultrasonography will be sufficient in cases where uterine abnormalities are present. Nevertheless, as there is no precise research on this issue, there is not a recommended method for such cases. For this reason, the healthcare providers should adopt a tailor-made approach.
What are the indications for hysteroscopy before IVF?
- In patients with infertility, the uterine cavity should be also routinely examined besides other tests. It must be ensured that the patient has a regular menstrual cycle, no compliant of abnormal bleeding and no pathological finding in uterus during examination and the method (HGS, laparoscopy and hysteroscopy) must be determined.
- Age over 35 years, abnormal vaginal bleeding and suspicious findings during examination requires the use of hysteroscopy for both investigation and treatment of uterine abnormalities. Hysteroscopy is obligatory after repeated unsuccessful IVF procedures.
The indications of therapeutic hysteroscopy performed before IVF are not different from the indications of the infertility testing. Therefore, the polyps located in the uterus must be removed. It is also preferable to remove the submucous myomas bulging into the uterine cavity. Obstructive intra-uterine adhesions should be resolved and, if necessary, the uterine cavity should be restructured. For this purpose, mucosal synechiae/adhesions should be treated.