When Is Hysteroscopy And Laparoscopy Needed In An Infertile Couple?

Are There Conditions Where It Must Be Performed More Than Once?


In couples applying for having a child, we first investigate whether there is a reason for the woman by performing gynecological examination of the woman, ultrasonography and hormone tests. Gynecological examination and ultrasound can reveal problems that have never caused complaints before. These may include uterine problems due to congenital or previous abortion or previous uterine surgery, swellings called hydrosalpinx due to obstruction in the tubes, or cysts due to endometriosis disease (chocolate cyst) or blockages in the tubes due to previous infections. Three-dimensional ultrasonography and uterus film (HSG) are the most commonly used methods in the diagnosis of uterine problems.


In congenital uterine anomalies, there may be morphological or structural problems in the uterus, such as curtains or T-shaped uterus. These structural disturbances can often lead to miscarriages, pregnancy problems such as premature birth, and delayed time-to-pregnancy or birth. For this reason, it is possible to look into the uterus with an endoscopic procedure when this problem is detected or in case of doubt, and it is possible to correct this problem at the same time. This procedure is called hysteroscopy. Hysteroscopy is a daily surgical procedure. In other words, the woman does not need to stay in the hospital, the discharge is planned on the same day. Usually the procedure is completed within 15-30 minutes, depending on the probing in the womb. It is done with anesthesia.


Uterine anomalies are various. Intrauterine curtain, morphological disorder called T-shaped uterus, intrauterine adhesions, myoma and polyps in the uterus are the most common problems. Sometimes intrauterine curtain is wide-based and this curtain can not be completely destroyed in a single session or it may be necessary to see the uterus again by hysteroscopy after 1-2 months if there is any residue or adhesion.


Hysteroscopically removed myomas that pressurize the uterus or fill the uterus may require hysteroscopy more than once if the myoma is large. Also, since it may cause adhesions in the uterus after removing those large fibroids, it may be necessary to look into the uterus with hysteroscopy 1-2 months following operation.


On the other hand, since the polyps are softer in nature, hysteroscopy is usually sufficient once and for all, and can be completely removed.


Intrauterine adhesions sometimes may require hysteroscopy more than once. Mild and small adhesions can be treated in 5 minutes and in one occasion but, sometimes dense adhesions might require successive hysteroscopies. It is also possible to objectively evaluate the uterus by taking a uterus film (HSG) between those hysteroscopies.


It is also necessary to enlarge the uterus and occasionally to perform more than one hysteroscopies in the uterine morphological disorder called T-shaped uterus. Again, successive hysteroscopies and HSG films in between the hysteroscopies to evaluate the uterus might be needed.


Laparoscopic surgery may be required more than once if there is dense adhesions in the tubes, ovaries and abdomen or if there is a widespread endometriosis. Here, too, it would be good to make use of MRI in the presence of a problem such as uterine fibroid or advanced endometriosis, in tuberculous pathologies and, for evaluation during interim periods where the pathology can not be completely rectified.


Endoscopic procedures such as gynecological hysteroscopy and laparoscopy are successfully performed. Occasionally these operations may be needed more than once. Optimum results and pregnancy can be achieved by evaluating the patient repeatedly and well before and during these endoscopic procedures by using HSG, 3D ultrasound or MRI.


Banu Kumbak Aygun, M.D., Professor