Infertility is a complex condition which can have multiple causes. A comprehensive examination of all possible causes of infertility includes an analysis of the general health of a couple, as also a detailed and thorough assessment of the woman’s reproductive tract including the uterus, fallopian tubes, ovaries & the vaginal canal in addition to her hormonal profile . While most of this information can be obtained through a combination of clinical examination, blood tests & a good pelvic ultrasound, the assessment of the inside of the uterine cavity & cervical canal requires the use of an advanced technique called Hysteroscopy. Hysteroscopy involves the use of a special instrument – A Hysteroscope, to not only visualize the cavity of the uterus and cervix but also simultaneously treat some of the pathologies that may be detected at the time of visualization.
Very often, certain conditions that cannot be detected by routine physical examination, may be detected through hysteroscopy and can then also be corrected immediately, avoiding the need for a repeat surgery. Hysteroscopy has thus become a frequently recommended procedure for the evaluation of infertility, recurrent miscarriages and abnormal uterine bleeding.
Hysteroscopy is generally undertaken for :
- Checking any abnormality in the shape or size of the uterus or looking for any septum (midline separation) in the cavity of the uterus. The septum can be removed by hysteroscopy but a much more complex surgery may be needed for bicornuate uterus (a situation where the cavity is divided into two parts by birth).
- To look for any scar tissue in the cavity of the uterus which can be removed in the same sitting . The scar tissue may have formed after a previous surgery or infection & could be preventing a pregnancy from implanting well, leading to recurrent miscarriages.
- To diagnose any abnormality in the shape of the uterine cavity due to the presence of a fibroid tumour or a polyp in the cavity. Any fibroid or polyp can also lead to infertility & miscarriage. Certain fibroids & almost all polyps can be removed during the same sitting of hysteroscopy, using an operative hysteroscope.
- To assess the status of the ostia , i.e the openings of the fallopian tubes into the uterine cavity. If these are found to be blocked then your doctor may attempt to cannulate & open them while doing hysteroscopy.
- To take a biopsy of the Endometrium ( uterine lining that lodges & nourishes a pregnancy ). This collected tissue can then be tested for any tubercular infection, evidence of a precancerous or cancerous tissue and also for any discordance between the hormonal cycle & the growth of endometrium.
- To assess any abnormality in the cervical canal.
- Occasionally, a displaced IUCD may be found in the cavity and removed in the same sitting.
What is a Hysteroscope ?
A Hysteroscope is a narrow, telescope-like instrument having a camera and an integrated light source. It is inserted into the uterine cavity through the vagina and the cervix and enables the doctor to visually examine the cavity of the uterus & cervix, the Endometrium and the ostia. The images are displayed on a monitor, which helps the doctor to also conduct any procedure or undertake any corrective surgery, as required.
What happens in Hysteroscopy ?
Hysteroscopy is generally undertaken by a Gynaecologist in the Operation theatre after the patient has been administered anaesthesia. The cervical canal is gradually dilated by stretching till it is possible to introduce the hysteroscope into the uterine cavity. This procedure does not involve any incision or cut over the cervix. Once the cavity of the uterus has been distended by introducing fluid, to enable a better visualization of its contents, the doctor carefully examines the cavity and the lining of the uterus, so that any abnormality that is detected can then be treated accordingly. The doctor may also decide to take a biopsy from any area that appears visually abnormal and send the tissue to the lab for testing. The hysteroscope is withdrawn after the examination and the patient can usually go home 4-6 hours after the procedure. Occasionally, an overnight stay in the hospital may be recommended for exceptional cases.
Nowadays the option of office hysteroscopy, which is undertaken in the OPD without anaesthesia, is also becoming available. In this, a very narrow Office Hysteroscope (of diameter less than 5 mm) is used, but only for diagnostic purposes. Any operative intervention, if needed, must be undertaken later in the OT under administration of anaesthesia.
What can be expected after the procedure ?
Usually, one may be discharged from the hospital on the day of the procedure itself. One may experience mild pain in lower abdomen or some cramping for a few days along with a little bit of vaginal bleeding or spotting. The doctor may prescribe some medications for these.
In most cases, one is able to resume normal physical activity in a couple of days unless the doctor specifically advises otherwise. Restarting sexual activity may however take a while depending upon the findings of the hysteroscopy.
What are the risks involved?
Hysteroscopy is a relatively safe procedure when undertaken by a competent gynecologist. A few unforeseeable complications may however occur in rare cases:
- Perforation of the uterus happens quite rarely and is usually treated conservatively by monitoring vital parameters and keeping the patient under observation. Occasionally, a surgical intervention may be needed to correct the defect.
- The possibility of an infection exists as with any other surgical intervention
- There may be excessive bleeding in some cases, which is also usually managed conservatively
- Very rarely, there are chances of the distending fluid or air entering into the blood vessels & causing a life threatening embolism, electrolyte imbalance or abnormalities related to blood clotting.
Serious or life threatening complications are however extremely rare and Hysteroscopy is generally considered a very safe & effective way of diagnosing gynaecological or fertility problems. In case of any concerns, whatsoever, it is advisable to discuss all the issues with the doctor before deciding to undergo a hysteroscopy.