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Diagnosing Infertility

Diagnostic hysteroscopy

Diagnostic hysteroscopy is the gold standard for evaluation of the uterine cavity and thus an essential part of the infertility investigation and fertility treatment. It is indicated in cases of past intrauterine surgical procedures, abortions, repeated failures and uterine lining (endometrium) disorders.
Our clinic is equipped with a special hysteroscope with a diameter of just 2.7mm that allows performing the examination here in office with no need of an operating room or anesthesia and it is essentially pain free.
During the examination, both the doctor and the patient (and her partner) can view the findings on a TV screen and talk over the findings. The pictures are digitally saved for future reference. Finally, the patient receives the full uterine evaluation in writing.
Hysteroscopy allows evaluation of the fallopian tubes opening to the uterus, but not the tubes themselves. To address this need we developed a unique technique combining both hystero-echovist and hysteroscopy. This technique enables examination of both uterine cavity and fallopian tubes patency with no need of anesthesia, no risk of invasive laproscopy, no exposure to radiation, no contrast media and importantly it is essentially pain free.
Hysteroscopy is considered nowadays as the gold standard for uterine cavity evaluation. It allows direct visualization of the uterine cavity (as well as fallopian tube origin and cervix) via an optic fiber inserted through the vagina and cervix.
This procedure can help diagnosing intrauterine adhesions (resulting from previous infections or curettage), intrauterine septum, polyp (overgrowth of uterine lining) or fibroid (overgrowth of uterine muscle) - all of which might interfere with proper implantation or cause early miscarriage. We can also evaluate inflammation, take a sample for biopsy or culture, identify adenomiosis and examine the cervix. Minor surgical procedures, such as ablating minor adhesions, can also be done during the test. Since adhesions can be formed following operative hysteroscopy, it is sometimes recommended to perform a diagnostic hysteroscopy several weeks after to treat the newly formed adhesions before they stabilize and become hard to remove.
Diagnostic hysteroscopy is occasionally recommended prior to in-vitro fertilization (IVF). Nevertheless hysteroscopy is indicated after repeated failures even when vaginal ultrasound (US) reveals no findings, since it can miss minor adhesions which still might interfere with implantation. In cases of thin uterine lining (under 7mm) hysteroscopy is recommended to examine structural abnormalities that could interfere with the proper endometrial proliferation.
Diagnostic hysteroscopy should be performed in the follicular phase of the menstrual cycle before the proliferation of the uterine lining (that is between the last day of the menstrual period and ovulation). Pregnancy should be rules out before the procedure, since it can compromise the pregnancy. Hence, sexual intercourse should be avoided from the last menstrual period until the test is performed.
The procedure can be done with anesthesia for women fearful of the test. In these cases Dr. Itai Bar-Hava will perform the procedure in the operating room and if major findings are discovered the patient is sent to operative hysteroscopy.
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