Hysteroscopy is considered the gold standard for evaluation of the endometrial cavity.
It allows direct visualization of the shape, size and location of any endometrial pathology. Small polyps are a common finding and can easily be removed. Fibroids which protrude into the cavity can be approached as well. It requires fiber optic hysteroscopy equipment and anesthesia (local or sedation), which makes it more costly than the other methods if used only for diagnostic purposes ($800-1500). The risks include infection, bleeding, abdominal pain and anesthesia related complications. Although it does not provide direct information about tubal pathology, fluid or gas passage through the internal tubal ostia indirectly indicates tubal patency. Method of hysteroscopy and images
Figure 1. Fiber optic view into the uterus
|Figure 2. Polyp||Figure 3. Resection of fibroid tissue|
When do we use Hysteroscopy?
Hysteroscopy is best utilized when there is high suspicion of an intracavitary lesion in which the procedure is both diagnostic and therapeutic. Limited information about the tubal status is also obtained. Its routine use may be limited by cost and the need for anesthesia. If a lesion is encountered, a decision will need to be made as to when to remove it and how soon after removal, will be safe for the patient to undergo an IUI or IVF treatment cycle. If the lesion is not adherent to the wall of the uterus i.e. is like a cherry on a stalk, and is removed by simply excising the stalk,
the patient can enter treatment very soon after the procedure because there is limited associated inflammation of the cavity. However, if it is necessary to do an extensive dissection of the lesion, at least 6 weeks will be required to allow the cavity to heal. This information is provided for patients by New York Fertility Services, which offers thoughtful and thorough infertility evaluation and treatment including in vitro fertilization (IVF) in New York City.
1. Vandekerckhove P. Cochrane Database System. 2000.
2. Spring DB. Radiology. 2000.