Role of Hysteroscopy in IVF

Before we talk about the role of hysteroscopy in IVF, you should know about the in-vitro fertilization process or test tube technique.

What is IVF?

It is an artificial fertilization technique where the sperms and ovums are collected from the couples first, then the quality sperms are isolated for the fertilization.

There are two types of artificial fertilization process: -

  1. In-vivo fertilization
  2. In-vitro fertilization

In case of in-vitro fertilization the fertilization process is done outside of the body or mothers' womb by manually combining an egg and sperm in a laboratory dish. After the embryo is formed, it is again placed in the mother's womb to let it mature.

What is Hysteroscopy?

Hysteroscopy is a procedure where a telescope fitted with a camera and light source, is inserted through the vagina, through the mouth of the womb, into the uterine cavity. This helps us understand the how the inside of the uterus looks.

How does it differ from Laparoscopy?

Laparoscopy is putting a telescope inside the tummy through the belly button. It involves making a small hole in the belly button which Hysteroscopy does not. If we imagine a building, Laparoscopy is looking at the building from an aerial view while Hysteroscopy is looking at the building from inside.

What are the various problems which can be diagnosed?

Polyps (grape like structures), fibroid tumors, Septum (wall like structure arising from the room) are some of the problems which can be diagnosed AND tackled at the same sitting during Hysteroscopy. Additionally biopsies can be taken to test for infection etc. the cavity length can be ascertained to exactly judge where the embryo should be dropped during IVF embryo transfer.

Can’t the problems be diagnosed by Ultrasound or HSG?

3D ultrasound and HSG although being excellent modalities of investigation, do miss intra uterine problems in upto 30% cases. Thus Hysteroscopy remains the Gold Standard for the same.

Why is Hysteroscopy important before IVF?

Despite progressing improvement of IVF, the maximum implantation rate per embryo transferred does not usually exceed 30%. Even if egg retrieval and fertilization occur successfully in the process of IVF, there is an unexplained drop between embryo transfer and occurrence of pregnancy.
In anything between 11-45% cases of failure, there has been some problem found inside the uterine cavity. Thus it only makes sense to solve this problem and increase the IVF success rates, though Dr. Rajeev Agarwal (director of Care IVF) stated that if everything goes normal then there is 40% IVF success rate at the very first attempt of IVF (in-vitro fertilization) process.

 

 

Do you advocate always doing Hysteroscopy before even the first IVF cycle or would you wait till at least one failure?

This one is a tough question to answer. A study done in October 2013 looked at the cost effectiveness of doing Hysteroscopy before 1st IVF vs. doing it later. They found that although Hysteroscopy would need an additional cost, the amount it would save by way of preventing few extra IVF cycles, would justify its use before even the 1st IVF cycle. Having said that, in a country like India where costs can be a problem, what I have tried to do is modify this rule a bit. Where patients come with problems like male factor or poor eggs, since that constitutes a definite problem, I give them a benefit of doubt and do Hysteroscopy only if we fail 1st time. In other cases we prefer doing Hysteroscopy first.

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