Hysteroscopy and Sterility
Role of Hysteroscopy in Sterility
The role of hysteroscopy as a first-level examination in the study of the causes of infertility and sterility is described. Hysteroscopy is used to assess the presence of anatomical causes and pathologies that negatively interfere with the nesting of the embryo and the continuation of pregnancy and to remove them with an operative hysteroscopy
Prerequisites:
50% of women give birth after the age of 35, 6% after 1 39 years. In 2006 27900 mothers over 40 gave birth
In recent decades, there has been a progressive increase in the frequency of pregnancies and births in women in the older age groups
28.2% of medically assisted procreation cycles involve women over 40 years old
The causes of failure and factors that positively influence medically assisted procreation are:
- Embryonic quality
- Endometrial receptivity
- Endometrial receptivity is influenced by fromthe anatomy of the uterine cavity and the endometrial thickness
- The existence of endocavitary pathologies may adversely affect endometrial receptivity and thus prevent successful assisted fertilisation
The most effective technique for assessing the uterine cavity and endometrium is hysteroscopy. 3D ultrasound in experienced hands can also be useful. This is contained in the guidelines of the Italian Society of Gynaecological Endoscopy which states:
A 'screening' hysteroscopy should be performed before deciding to include patients in an IVF programme particularly after 1 or 2 failures in order to minimise any negative influence that a uterine pathology might have on the outcome.
The non-invasiveness and safety of outpatient hysteroscopyassociated with the infertile couple's desire to quickly achieve diagnostic goals that are often a source of anxiety and uncertainty, make this method recommended in the diagnostic evaluation of the uterine cavity
The detection of pathologies within the uterine cavity must be combined with appropriate treatment of them in order to improve reproductive chances.
And what should a diagnostic hysteroscopy assess in a woman suffering from sterility, infertility or polyabortion?
- External uterine ostium (stenosis, polyps).
- Cervical canal (stenosis, direction, polyps, myomas).
- Internal uterine ostium (stenosis).
- Uterine cavity.
- Endometrium.
- Tubular hosts
The benefit of hysteroscopy in increasing the chance of pregnancy in the next cycle, both in the case of pathological and normal hysteroscopies, is scientifically proven. Several possible mechanisms have been proposed to explain this beneficial effect of hysteroscopy
But above all, with hysteroscopy it is possible to detect the presence of:
Congenital pathologies(uterine malformations such as septum, arched, unicornuate, bicornuate, funnel-shaped, t-shaped uterus)
Acquired pathologies ( polyps, myomas, synechiae and asherman syndrome, isthmocele, endometritis, low and high risk endometrial hyperplasia, endometrial cancer )
According to the scientific literature, the incidence of endometrial disease in infertile women ranges from 23 to 40% of cases.
Many studies agree that removing these pathologies with an operative hysteroscopy significantly improves the chances of having a pregnancy and carrying it to term. Even the guidelines of the Italian Society of Gynaecological Endoscopy state that Hysteroscopic evaluation of the uterine cavity is recommended in women with recurrent miscarriages.
The diagnosis and hysteroscopic treatment of uterine malformations and endocavitary adhesions in such patients can improve live birth ratestherefore their treatment should always be recommended.
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