hysteroscopy infertility workup

hysteroscopy infertility workup

Can hysteroscopy help infertility?

Can I get pregnant after hysteroscopy?

Why is hysteroscopy done before IVF?

Which is more painful HSG or hysteroscopy?

How can I unblock my fallopian tubes naturally?

Can HSG open blocked tubes?

It is widely accepted that a complete infertility workup should include an evaluation of the uterine cavity. Today, hysteroscopy is considered the gold standard for evaluating the uterine cavity, and due to improved endoscopic developments, can be performed reliably and safely as an office procedure.

One of the basic steps of the infertility workup is to assess the shape and regularity of the uterine cavity. Historically, and still today as it turns out, the HSG has been the most commonly used test for this purpose. During the last two decades, however, several studies have demonstrated that when the uterine cavity has to be investigated within the infertility workup, hysteroscopy is much more accurate than HSG.

It was shown that 54.3% of intrauterine adhesions diagnosed on HSG were not found on direct hysteroscopic examination. Another recent study comparing the diagnostic value of HSG and hysteroscopy in female infertility showed that among 79 women with normal HSG, 28 had abnormal findings on hysteroscopy, for a false negative rate of 35.4%. Of the 135 women with an abnormal HSG, hysteroscopy demonstrated a normal uterine cavity in 21, a false positive rate of 15.6%. The sensitivity of HSG was 80.3% in revealing intrauterine abnormality and its specificity was 70.1%. Other investigators have reported similar results. Therefore, it appears that in more than one third of the cases where the HSG is interpreted as normal, it may supply a false reassurance. These women, wrongly treated as women with a normal uterine cavity, would probably undergo other `unjustified’ tests within the infertility workup, while the cause of their infertility might be the missed intrauterine lesion. Furthermore, hysteroscopy allows exact location of intrauterine lesions, and provides a better way than the blunt curettage to ensure excision of such lesions.

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Can hysteroscopy help infertility?

Hysteroscopy and laparoscopy are useful tools for the evaluation and treatment of various structural causes of infertility. During a hysteroscopy, your doctor inserts a hysteroscope — a thin tube with light on the end — into your vagina. They’ll be able to see into your cervix and inside your uterus. If they find anything abnormal, they can take a sample for later testing.

Among the most common reasons for a hysteroscopy are periods that are longer or heavier than normal, or bleeding between periods.

You might also need the procedure in these situations:

  • Your Pap test results are abnormal.
  • You’ve been bleeding after menopause.
  • There are fibroids, polyps, or scarring on your uterus.
  • You’ve had more than one miscarriage or problems getting pregnant.
  • Your doctor needs a small tissue sample (biopsy) of the lining of your uterus.
  • You’re having a sterilization procedure as a permanent form of birth control.
  • Your IUD has come out of place.

Read more about: Hysteroscopy for unexplained infertility

Can I get pregnant after hysteroscopy?

Some studies have shown that removing endometrial polyps using hysteroscopy improves fertility and increases pregnancy rates, irrespective of the size or number of the polyps. According to our results, the optimal waiting periods for subsequent fertility treatment after hysteroscopic surgeries are 1–2 months for polypectomy and septal incision, and as long as 3 months for myomectomy and adhesiolysis.

Read more about: Can hysteroscopy cause infertility?

Why is hysteroscopy done before IVF?

Hysteroscopy is used to diagnose and treat problems of the uterus, according to the American College of Obstetricians and Gynecologists (ACOG). A hysteroscope is a long, thin, lighted device which is inserted into your uterus through your vagina. It projects an image on a screen and lets the physician see your uterus.

Hysteroscopy is commonly used when a woman has abnormal uterine bleeding. This means her periods are too heavy or last much longer than normal, they occur too often or less frequently than normal, or that she has bleeding in between her periods. It can also be used to remove scar tissue, called adhesions, to locate an intrauterine device (IUD), or to perform sterilization by blocking the fallopian tubes. Hysteroscopy is one of the tests a fertility doctor may prescribe to evaluate the possible causes of infertility. Other tests include semen analysis, trans-vaginal ultrasound, hysterosalpingograms (HSG), and blood tests for ovarian function.

Unsuccessful IVF attempts usually are due to factors in the embryo, such as genetic problems, or issues with the woman’s uterus. In the past many fertility clinics routinely performed hysteroscopy on women who had failed IVF cycles, to look for uterine growths or scar tissue and remove them. There are other, non-invasive methods of assessing the uterine cavity including hysterosonography (HSN) where a small amount of salt water is infused into the uterus and an ultrasound is performed to assess the uterus. Typically hysteroscopy is reserved for cases in which an abnormality has been identified on the HSN or HSG.

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Several studies had seemed to find some benefit to hysteroscopy after an IVF cycle had failed. Some clinics routinely performed the procedure on every woman before beginning IVF treatment, believing that removing polyps or scar tissue before starting IVF gave the treatment a better chance to succeed.

However, a large randomized study conducted in Europe found no significant difference in IVF success rates between those who had hysteroscopy before IVF and those who did not. The study was reported at a meeting of the European Society of Human Reproduction and Embryology (ESHRE) in 2014. The 700 women in the trial had all had failed IVF cycles and were under age 38. They were randomly assigned to have a hysteroscopy or not to have the procedure. This is important because it reduces chances for bias in the study and makes the findings more reliable.

Live birth rate in the group who had hysteroscopy was 31 percent, while the group who did not have hysteroscopy had a live birth rate of 29 percent. In groups of that size, this is not a significant difference.

So what should you do? Should you have hysteroscopy before you begin IVF? Is it an added expense and invasive procedure for no good reason? Or is it good practice to give your IVF cycle the best chance of success? While there is no consensus of opinion or practice yet among reproductive endocrinologists, most agree that a preliminary non-invasive test such as HSN should be performed first. If an abnormality is identified, then hysteroscopy is indicated. If it is normal, then hysteroscopy is probably not necessary. It’s important to find a fertility doctor that you trust, and work together with him or her to find the best solution for you.

Read more about: Hysteroscopy infertility treatment

Which is more painful HSG or hysteroscopy?

Patients experience various degrees of pain during endometrial evaluation. Hysterosalpingography is associated with more pain compared to office hysteroscopy. Patients based on their pain experience will prefer Hysteroscopy in the assessment of endometrial pathologies during infertility workup. There is a need for pain alleviation in these patients undergoing these procedures.

Read more about: diagnostic hysteroscopy infertility

How can I unblock my fallopian tubes naturally?

Blocked fallopian tubes can be caused by the following:

  • endometriosis, which can cause a tissue buildup in the tubes
  • pelvic inflammatory disease, a disease that can cause scarring
  • fibroids, which are growths that can block the fallopian tube
  • scars, which can be caused by ectopic pregnancies or abdominal surgery
  • some sexually transmitted infections, such as chlamydia and gonorrhea

If you’re trying to get pregnant and have blocked fallopian tubes, you may look for natural treatments to unblock them.

Many commonly used natural treatments aim to reduce inflammation in the tubes. While these natural treatments remain popular and some claim success, they haven’t been scientifically proven.

  • Vitamin C

Vitamin C is an antioxidant that can reduce inflammation by helping your immune system function better. For this reason, it’s thought to heal scarring and could have a positive effect in the fallopian tubes.

According to the Office for Dietary Supplements, it’s best to get all your vitamin C from your diet. However, it can also be taken in a supplement. Vitamin C isn’t stored in the body so it must be taken in every day.

In high amounts, vitamin C can cause diarrhea and stomachache. Otherwise, there aren’t any serious side effects.

Unfortunately, vitamin C has never been tested for its ability to unblock tubes. We just don’t know whether it’s an effective treatment. Nevertheless, it’s important to ensure you consume sufficient vitamin C for your overall health.

  • Turmeric

Turmeric is a natural anti-inflammatory. Curcumin, the active ingredient in turmeric, has been shown to reduce inflammation. You can consume curcumin in supplement form, add turmeric to your food, or have a turmeric drink.

There are no known side effects of turmeric when taken in small doses. However, in doses of more than 8 grams per day, it can have an adverse effect. Be sure to take the correct dosage of turmeric, or better yet, add the spice to your cooking.

While turmeric has many benefits, there are no studies on whether or not it can help unblock tubes.

  • Ginger

A common ingredient with multiple benefits, ginger is another natural anti-inflammatory. A 2014 paper showed that gingerol, the active ingredient in ginger, is both an antioxidant and an anti-inflammatory.

There’s no scientific evidence that ginger can unblock fallopian tubes.

  • Garlic

Garlic is often suggested as a way to boost fertility and unblock tubes. A 2004 study on the fertility benefits of garlic suggested that it might be able to improve fertility. More evidence is needed to confirm this.

Beyond that dated study, there isn’t any evidence that garlic can improve fertility. That said, a moderate amount of garlic is perfectly safe, so it might be worth trying and there are other health benefits of adding garlic to your diet.

  • Lodhra

A commonly-used Ayurvedic treatment, lodhra is sometimes recommended to boost fertility and unblock fallopian tubes. However, there isn’t any scientific evidence.

  • Dong quai

A plant frequently used in Chinese herbal medicine, dong quai is often recommended for fallopian tube blockages. It’s one of the most commonly used Chinese herbs for treating reproductive issues.

According to a 2015 meta-analysis, Chinese herbal medicine could double the pregnancy rates in female infertility. The analysis looked at a total of 4,247 women in treatment for infertility. However, no studies have specifically looked at whether dong quai could unblock fallopian tubes.

  • Ginseng

Some natural and Eastern doctors recommend ginseng to increase fertility. While ginseng seems to have a number of potential benefits, there’s no evidence that it can improve female fertility, let alone treat blocked fallopian tubes.

  • Vaginal steaming

An alternative treatment that’s recently risen in popularity, vaginal steaming supposedly treats multiple conditions, from menstrual cramps to infertility. It’s also recommended by some as a treatment for unblocking fallopian tubes.

Unfortunately, there’s no evidence behind these claims. It doesn’t seem anatomically possible for steam to enter the fallopian tubes through the cervix. Additionally, steaming the vagina might lead to a burn or an infection. This can actually harm your fertility.

  • Fertility massage

Some alternative medicine practitioners suggest fertility massages to unblock fallopian tubes. These usually involve warm oil massages on the abdominal area. There’s no scientific evidence that this works.

  • Mugwort

Mugwort is an herb sometimes recommended for boosting fertility. It’s also recommended for unblocking fallopian tubes.

Mugwort has a long history of use for fertility in a number of different cultures. It was used throughout Europe and Asia for centuries. It’s often used in Chinese medicine in the form of moxibustion, which involves burning mugwort over an acupressure point.

A 2010 review of studies shows that the only thing moxibustion could help with is turning a breech fetus head-down in the uterus. Unfortunately, there’s no evidence that it affects fertility or blocked fallopian tubes.

  • Castor oil

Castor oil is a popular home remedies for infertility and blocked tubes. It’s also commonly used to induce labor, although a 2009 review shows that it’s neither harmful or helpful in this regard.

There’s no scientific evidence that proves that castor oil unblocks fallopian tubes. However, there aren’t any risks associated with the topical application of castor oil, so it might be worth a try and it can moisturize to your skin.

  • Herbal tampons

Herbal tampons — that is, herbs inserted into the vagina — are popular home fertility treatments. However, there aren’t any studies that test the efficacy of this treatment.

Bear in mind that these tampons aren’t sterile, and they can lead to a vaginal infection. Use these with caution. Investigate each herb before use and work with a licensed practitioner.

  • Maca

Maca is a Peruvian plant with a number of reported benefits. One of those alleged benefits is that it boosts fertility. While a 2016 review of studies shows that it could improve semen quality, no evidence suggests it unblocks the fallopian tubes.

  • Exercise

Exercise is a lifestyle change sometimes believed to improve fertility and unblock fallopian tubes. A 2012 cohort studyTrusted Source that studied 3,628 women suggested that exercise can improve fertility levels. But so far, no studies have been conducted on the link between exercise and blocked fallopian tubes.

  • Reduce alcohol intake

Drinking alcohol hasn’t been directly linked with blocked fallopian tubes. However, it’s worth cutting out alcohol if you’re trying to conceive. This lifestyle change can improve your overall health and fertility.

  • Yoga

Many people who are trying to conceive practice yoga. Some people even recommend it for treating blocked fallopian tubes.

According to the National Center for Complementary and Integrative HealthTrusted Source, yoga could be an effective way to reduce stress. Stress can reduce fertility, so it may be worth trying stress-reducing techniques such as yoga if you’re trying to conceive. Unfortunately, there’s no evidence that proves yoga unblocks fallopian tubes.

  • Meditation

Similar to yoga, meditating is scientifically proven to reduce stress, according to this 2014 reviewTrusted Source. Meditation might be a useful tool for improving your fertility. Nevertheless, no studies have been conducted on whether meditating affects the fallopian tubes.

  • Improving diet

While diet is important when it comes to fertility, there’s no evidence linking diet to blocked fallopian tubes. It’s still a wise idea to eat a varied diet and stay hydrated so your body has sufficient nutrients while you’re trying to conceive.

You should take prenatal vitamins the year before you try to conceive as low folic acid, a nutrient found in green leafy vegetables, has been associated with spinal bifida and other similar problems.

Read more about: Hysteroscopy

Can HSG open blocked tubes?

Normally eggs produced by the ovaries pass down fine, narrow tubes called fallopian tubes to reach the womb. A HSG can determine if these tubes are open or blocked. If either or both of these tubes are blocked then the chances of becoming pregnant are much reduced.

Read more about: Laparoscopic infertility treatment in iran

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