Hysteroscopy, Diagnostic for Infertility
A hysteroscope is a small tube connected to a light source and camera. It is used to view some of the internal female pelvic organs. For example, a hysteroscope can be used to examine:
the opening of the cervix. This is the lowest part of the uterus that must dilate or widen to allow a pregnant woman to deliver her baby.
the uterine cavity. This is the inside of the uterus, or womb, which holds a baby during pregnancy.
the openings of the fallopian tubes, or "tubes." These are thin tubes that allow a woman's eggs to pass from the ovary to the uterus so that fertilization of an egg with sperm may occur.
Hysteroscopy is considered a diagnostic procedure if it is done only to view these organs, meaning no surgery is done.
Who is a candidate for the procedure?
Couples in which the woman is age 35 or under are considered infertile if they have not conceived after 12 months without using birth control. If a woman is 35 or older, 6 months of trying to get pregnant without success is considered a possible case of infertility. Roughly 15% of all couples in the United States are infertile.
Primary infertility refers to a couple that has never conceived. This means that they have not experienced a miscarriage, ectopic pregnancy, or a pregnancy in which the fetus is abnormally located outside of the uterus, or live birth. Secondary infertility refers to cases in which pregnancy has occurred in the past but cannot be achieved currently.
A woman is most fertile in her mid 20s. At this point, she has a twenty percent (20%) chance of getting pregnant if she has intercourse during ovulation. Ovulation is the point of highest fertility in the menstrual cycle when an egg is released from the ovary. Certain events must take place in a woman's body for pregnancy to occur. These include:
ovulation. This is the release of an egg from the ovary. It usually happens midway through a woman menstrual cycle. For most women, this is 14 days before the start of her next period. The egg lives only 24 hours and must be fertilized during this time.
fertilization. This is the uniting of a woman's egg and a man's sperm.
implantation. This is the attaching of the fertilized egg to the lining of the uterus.
Problems in either the man or the woman may be responsible for the failure to conceive. It is estimated that thirty percent (30%) of infertility is due to female causes. Male factors account for another 30%. In the remaining cases, there is a either a combination of male and female factors or the cause remains unknown.
Factors which may be seen during the procedure that increase the risk of infertility include:
scarring of the fallopian tubes, which is often due to pelvic inflammatory disease (PID). PID is an infection of the female pelvic organs that usually occurs when a sexually transmitted disease goes untreated.
exposure to diethylstilbestrol (DES), a drug that used to be given to pregnant women, as an unborn child in the womb
an irregularly shaped or abnormally formed uterus
scar tissue in the uterus, called adhesions
polyps or uterine fibroids, which are both benign or non-cancerous tumors of the uterus
There are other causes of infertility that cannot be seen with this procedure.
How is the procedure performed?
This procedure is most often done during the first 2 weeks of a woman's monthly cycle. This is to make sure she is not pregnant at the time. The procedure can be done in the doctor's office. In this case, local "numbing" medicine is used.
Other operations may be done at the same time as this procedure. In these cases, the procedure is performed in the hospital and a woman is put completely to sleep to control pain.
The first step is to clean the cervix and vagina with special soap. This reduces the amount of bacteria in the area. The cervix is dilated or widened with special tools to allow the hysteroscope to pass through. The uterus is then inflated with fluid or gas. This allows the doctor to see the inside more clearly. If any defects or abnormal growths are noted, they can be removed with small tools inserted through the hysteroscope. Small pieces of tissue can be also taken in this manner, which is called a biopsy. Photos can be taken of the inside of the uterus. Tissue that is removed is sent to the lab for analysis. The procedure usually takes 20 to 45 minutes.