Endoscopy for Infertility
Hysteroscopic and Laparoscopic procedures belong to the broader field of Endoscopy and their applications in infertility are briefly given.
Hysteroscopy
Hysteroscopy is a procedure that allows the inspection of uterine cavity in order to diagnose and manage uterine causes of infertility. A hysteroscope is a slender, lighted telescope like device and is inserted through vagina. This procedure can be either diagnostic or operative. It is generally carried out under anesthesia. The patient is told not to eat or drink for 6 hours before the hysteroscopy.
Diagnostic Hysteroscopy
It is used to diagnose problems of the uterus. It is also used to confirm results of other tests, such as hysterosalpingography (HSG). HSG is an X-ray dye test used to check the uterus and patency of fallopian tubes and tubal blockage. It is an out door procedure.
Operative Hysteroscopy
It is used to correct an abnormal uterine condition that has been detected during a diagnostic hysteroscopy. Small instruments required to correct the condition are inserted through the hysteroscope.
Endoscopic Surgery
The procedure is scheduled in the first week after menstrual period. This timing provides best view of the inside of uterus because endometrium lining is thin. The patient is kept under observations for a day.
Indications of Operative Hysteroscopy
It is used to correct the following uterine conditions: Polyps and fibroids, Adhesions also known as Asherman’s Syndrome, Uterine adhesions are bands of scar tissue that can form in the uterus and may result in infertility. Adhesions may occur because of infection or from previous surgery. Septum a malformation of the uterus that is present from birth for the diagnose of the cause of RPL when the woman has 2 or 3 miscarriages in a row.
Laparoscopy
Laparoscopic surgery, also called minimally invasive surgery (MIS), is a modern surgical technique in which operations in the abdomen are performed through small incisions (usually 0.5–1.5 cm) as opposed to the larger incisions needed in laparotomy. It makes use of images displayed on TV monitor to magnify the surgical elements.Laparoscope is a slender tube fitted with a fibre optic camera which is inserted into woman’s abdomen below navel to view the outside of uterus, ovaries and fallopian tubes. The abdomen is usually insufflated with carbon dioxide gas. This elevates the abdominal wall above the internal organs like a dome to create a working and viewing space. CO2 is used because it is common to the human body.
Indications of Laparoscopy: It can be useful in the infertility evaluation of young women with a history of
- Pelvic inflammatory disease
- Ectopic pregnancy
- Pelvic surgery
- Chronic pelvic pain
If adhesions or endometriosis are found during diagnostic laparoscopy then an operative laparoscopic procedure for improving fertility can be undertaken. The laparoscopic procedure is sometimes combined with a hysteroscopy when indicated.
Advantages: The endoscopic procedures have several advantages over the open abdominal surgery. They are relatively safe, less painful due to smaller incisions, require shorter hospital stay and shorter recovery time.For the best result you should choose best infertility centre.
Risks: Endoscopic procedures are relatively safe procedures. However, as with any type of surgery, complications are possible such as risks associated with anaesthesia, infection, heavy bleeding, injury to cervix, uterus, bowel or bladder. Such complications occur in less than 1 % of cases.