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By Aristidis Kainantidis

Hysteroscopy before IVF treatment

Prior to the IVF treatment, a number of preliminary screening tests are available for early detection of possible uterine abnormalities that might interfere in the process of successful implantation and have an impact on the final pregnancy outcome. In the last decade, specific modern endoscopic techniques have gained increasing acceptance, as the most reliable diagnostic tests for infertility, mainly hysteroscopy which allows direct inspection of the endo-cervix, the endometrial cavity and the internal fallopian os.

The procedure is simple and relatively painless. It is generally performed between the 6th and 10th day of the menstrual cycle. Mild anaesthetic may be used, only if needed. The woman herself can watch the procedure on a screen, if she wishes.

Hysteroscopy is performed by placing a hysteroscope into the uterine cavity (a thin long tube with 2.8mm diameter), usually without the need for cervical dilatation. Dilatation fluid is pumped into the uterus to facilitate the visualization first of the cervical canal and through that the uterine cavity and the internal os of the fallopian tubes, on the screen in real time.

The main advantage of hysteroscopy is the possibility it offers to inspect the endometrial cavity and diagnose pathologies e.g. polyps, adhesions, fibroids, uterine septae, intrauterine congenital malformations etc. These pathological conditions, not infrequently, are detected in women undergoing IVF treatment and may compromise the final treatment outcome.

The efficacy of hysteroscopy prevails over other alternative, non-invasive methods available for assessing the uterine cavity, including Hysterosalpingography (HSG) and Hysterosonogram  (HSN) where a small amount of normal saline is infused through the cervix and an ultrasound examination is performed to assess the uterus.

The other big advantage of hysteroscopy that should be emphasized is that the above mentioned pathologies can be diagnosed and treated in one single procedure. An operative hysteroscopy can be performed simultaneously by utilizing advanced micro-instruments inserted through the hysteroscope. These pathologies are often the cause of an IVF failure and miscarriage, with considerable psychological impact on the couple.

According to recent studies, endometrial ablation performed during hysteroscopy (scratching), even at the absence of definite pathological conditions, improves endometrial receptivity, implantation and pregnancy rates, especially in women with recurrent implantation failure (RIF), which remains a major challenge in IVF.

It is evident that both diagnostic and operative hysteroscopy are particularly effective in the management of infertility, used routinely of selectively

The European Society of Human Reproduction and Embryology (ESHRE) recommends the use of hysteroscopy to confirm and treat intrauterine pathologies, but not as a routine procedure.

In conclusion, hysteroscopy is a simple and safe method for the diagnosis of uterine pathological conditions related to infertility, through direct visualization and treatment in a single procedure. In addition to improving IVF/ICSI treatment outcome, it reduces miscarriage

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Aristidis Kainantidis

MD, PhD

Obstetrician – Gynecologist, Scientific Fellow, FIVI Fertility & IVF Center, European Interbalkan Medical Center

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