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In infertile couples, women are evaluated by doing gynecological examination, transvaginal ultrasonography and blood hormone tests.
Gynecological examination and transvaginal ultrasonography might reveal congenital or acquired uterine anomalies, obstructed tubes or endometriotic cysts (chocolate cyst disease). Structural uterine anomalies might lead to miscarriages, premature birth and difficulty in getting pregnant.
Therefore, in case of suspicion on ultrasound, it is possible to look inside the uterus with an endoscopic procedure and to correct the problem at the same time. This procedure is named as hysteroscopy.
Hysteroscopy is a daily surgical procedure. That is, it does not require hospitalization and patients can go home on the same day. Generally, the procedure is completed within 15-30 minutes although it varies according to the extent of the problem in the uterus. It might be performed under anesthesia, however, in some cases it can be done without anesthesia.
Uterine anomalies are variable. Uterine septum, T-shaped uterus, intrauterine adhesions, uterine fibroids and polyps are the most commonly seen uterine anomalies. Intrauterine septum may require hysteroscopic procedure more than once. Sometimes this septum is broad-based and complete resection might be impossible in a single session, or it may be necessary to see the uterine cavity again with hysteroscopy 1-2 months after the procedure and look for any residue or adhesion. Sometimes the cavitary myoma might be large, hysteroscopy may be needed more than once. Again after the removal of these large fibroids located within the uterine cavity, intrauterine adhesion may ocur. It is advised to look inside the uterus 1-2 months after the procedure with hysteroscopy again. On the other hand, endometrial polyps are soft, even if they are large, one hysteroscopic procedure is enough to remove them completely. Intrauterine adhesions are the uterine problems which may require hysteroscopy more than once. Sometimes very small amounts of adhesions are seen during hysteroscopy and removed in 5 minutes, however, in some other cases there may be widespread adhesions in the uterus and just one hysteroscopy may not be enough to remove all the adhesions and more than one hysteroscopy may be needed. In T-shape uterus cases, which is frequently expressed recently, it may be necessary to enlarge the uterine cavity sometimes in more than one hysteroscopy. Between hysteroscopic procedures, the uterus is evalauted with uterine film (HSG) or 3D sonography and decision to do another hysteroscopy is done accordingly. Ultrasonography and uterine film (HSG) are the most frequently used methods in the diagnosis of uterine problems. Endometrium thickness measured on menstrual cycle day 10-14 gives us valuable information about uterine cavity and adhesions. Again, it is possible to see the uterine cavity precisely with 3D ultrasonography.
In women who are suspected to have tubal pathology, ovarian cysts, endometriosis (chocolate cyst disease) or intraabdominal adhesions, laparoscopic surgery might be done to both diagnose and sometimes correct the pathology. In severe endometriosis cases more than one laparoscopic procedure might be needed. Laparoscopic surgery is successfully performed in tubal or ovarian pathologies in experienced hands. Similar to hysteroscopy, laparoscopy also does not require hospitalization or in severe cases just one night stay is enough.
Endoscopic procedures such as hysteroscopy and laparoscopy are performed successfully in gynecology. These operations might be needed to be done multiple times from time to time depending on the extend of the pathology. Optimal outcome and pregnancy can be achieved following those endoscopic procedures provided thorough evaluation of the woman is done prior to the procedure.
Banu Kumbak Aygun, M.D., Professor
Gynecology & Obtetrics