HYDERABAD: Hysteroscopy is now an integral part of infertility evaluation, as it is used both for diagnosis as well to surgically correct abnormalities for improving pregnancy outcomes. It gives panoramic view of cervical canal, cavity and also of the ostia. Hysteroscopy should be planned in follicular phase (after completing the period) as at this time the endometrium is thinnest thus providing a clear view.
A concomitant laparoscopy is indicated especially in surgeries like lysis of synechiae, excision of septum, removal of fibroid, removal of uterotubal occlusions. Laparoscopy can help to evaluate the external shape of the uterus, which clinches the diagnosis between a uterine septum, and a bicornuate uterus. Laparoscopy helps in early recognition of complications and can monitor a successful cannulation of an obstructed fallopian tube.
When to suggest diagnostic hysteroscopy
Intrauterine filling defect on HSG Recurrent pregnancy failure Difficulty in subsequent conception after MTP or D&C or IUCD use or uterine manipulation Altered bleeding pattern- secondary amenorrhoea, hypomenorrhoea, irregular bleeding Unexplained infertility
What to look for and how to deal with them Adhesions- These can be partial or complete which can be thin, fibrous or muscular. These are usually present with history of infertility or recurrent pregnancy loss rather than secondary amenorrhoea as is usually believed. These can be lysed by using scissors or electrocautery.
Uterine malformation- Out of all mullerian anomalies causing reproductive failure septum is the only condition amenable to hysteroscopic resection. Scissors or electrocautery loops can be used for removal of septum creating an adequate cavity that can support a pregnancy.
Polyps and fibroids- When detected in infertile patients, these warrant removal. At times large submucous fibroids may require two stage procedure.
Foreign body- Lost IUCD can be located embedded in the anterior or posterior walls. Ossified fetal tissue and bones can also be encountered in some situations.
Hysteroscopic surgery is advised n Uterine malformation Uterine synechiae Tubal occlusions Intrauterine polyps or fibroids.
(The author is a gynecologist, laparoscopic & robotic surgeon at Apollo Hospitla, Hyderabad. And can be reached @ drroomasinha@hotmail.com)