A Hysteroscopy is conducted under general anaesthesia. This enables diagnosis and at the same time, surgical improvement of the womb is also possible. It helps in detecting abnormalities at the neck of the womb, which can affect the procedure of embryo transfer. It can remove abnormalities inside the womb such as polyps, fibroids, adhesions and even womb defects from birth (Septum). These abnormalities not only decrease the success of IVF but, can also lead to miscarriages. The lining of the womb is an important factor affecting the success of IVF.
This can be evaluated at this time. The hysteroscopy is followed by gentle curetting (scraping) of the lining of the womb. This is sent for microscopic assessment to the pathology department. Infection and hormonal abnormalities in the lining of the womb can be diagnosed and then treated, thereby improving the success of IVF.
The massive benefit offered by the hysteroscopy makes it almost mandatory in every patient before IVF and certainly in patients with repeated IVF failures and recurrent miscarriages. The procedure does not involve any cut on the stomach, nor any pain and is performed on a day carebase. In India, this can cost as little as £300.
A Laparoscopy involves putting a telescope measuring 5 to 10 mm in diameter through the navel into the stomach. This helps us to visualise the reproductive organs (including the uterus, the fallopian tubes, the ovaries and the rest of the pelvis and abdomen) on the screen. Additionally, three small cuts of 5mm length may be required on the stomach to insert other instruments that are needed during the laparoscopy procedure.
A proper transvaginal sonography is crucial to diagnose tubal disease, ovarian abnormalities, uterine factors and other pelvic abnormalities that can adversely affect an IVF cycle. Tubal disease includes infections that lead to fluid collection within the tubes (hydrosalpinx), the ovaries may have cysts and the uterus may have fibroids and polyps.
If the ultrasonography has detected any of the above abnormalities, a laparoscopy becomes necessary to improve the outcome of the IVF cycle. If the tubes are infected and filled with fluid, they have to be disconnected from the uterus. If not, the unhealthy fluid can prevent the implantation of embryos in the cavity of the womb. It is important to ensure that both ovaries are free and located normally so that they are well accessible for the egg collection procedure.
Ovaries can be adherent due to adhesions resulting from conditions such as endometrioisis, pelvic infections and previous surgeries. In these situations, a laparoscopy can help in the breakdown of these adhesions and free the ovaries. Before starting an IVF cycle, cysts in the ovaries need to be removed. These could be simple cysts, endometriotic cysts or even complex cysts such as dermoids. This improves the success of the IVF treatment. If the uterus has fibroids which are large (>4cm) and if they are located within the cavity or near the lining of the womb, then it may be advisable to remove them.
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