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The exceptional role of hysteroscopy in the diagnosis of infertility: See and Treat

Dr Viktoria Mokhnii
Gynecologist & Reproductologist, Ekstramed Reproductive Medicine Clinic
THE EXCEPTIONAL ROLE OF HYSTEROSCOPY-EKSTRAMED
From this video you will find out:
  • What role does hysteroscopy play in the diagnosis and treatment of infertility? How is it performed, and when should it be indicated?
  • Can uterine fibroids be a cause of infertility? How are they treated?
  • How is chronic endometritis diagnosed, and what are the treatment options for patients with unexplained infertility?

The exceptional role of hysteroscopy in the diagnosis of infertility: See and Treat

During this session, Dr Viktoria Mokhnii, Gynecologist & Reproductologist at The Ekstramed Reproductive Medicine Clinic, discussed Hysteroscopy as a cutting-edge diagnostic and therapeutic technique that allows physicians to visualize and address various uterine abnormalities with precision and efficacy. Dr Mokhnii shared her extensive knowledge and expertise in the field, enlightening attendees on the remarkable benefits of hysteroscopy in diagnosing infertility.

Hysteroscopy is an invaluable diagnostic method for assessing the uterine cavity. It can identify both physiological and pathological changes, even when transvaginal ultrasounds yield normal results. Abnormalities detected during hysteroscopy can be associated with up to a 45% failure rate in IVF protocols.

Hysteroscopy is typically performed with short anaesthesia, ensuring patient comfort. Over the years, advancements in IVF have highlighted the importance of addressing implantation failure, where embryos fail to attach to the uterine lining. This failure can result from a variety of maternal and embryonic factors.

Factors contributing to Implantation Failure

Implantation failure can be attributed to factors such as uterine abnormalities, hormonal imbalances, and thrombophilia. Embryonic factors, including embryo quality and compatibility, also play a significant role. Understanding these factors is crucial in achieving successful pregnancies.

In a study covering the period from 2017 to 2020, a clinic of Great Britain and Greece took part, with 334 patients, and the conclusion of the study was a higher percentage of successful live birth and successful pregnancy was obtained in the group with hysteroscopy performed before Embryo transfer, 42 percent versus 26 percent without the hysteroscopy.

Clinical cases

Three clinical cases underscore the significance of hysteroscopy in diagnosing and treating infertility.

Case 1: Chronic Endometritis

A 27-year-old patient with a history of ectopic pregnancy presented with chronic endometritis and other issues detected through hysteroscopy. After treatment with irrigation of the uterine cavity with antibiotics every second day, anti-inflammatory therapy, hystero – resectoscopy of polyps of the uterine cavity, synechiae, areas of hyperplastic endometrium, she successfully achieved pregnancy.

Case 2: Uterine Myoma and Fibroids

A 34-year-old patient battling 11 years of infertility. She had undergone 5 IVF attempts with pre-implantation genetic screening, but persistent uterine myomas posed a significant obstacle. Additionally, there was a history of uterine polyp removal, complicating her infertility journey. After discovering a uterine myoma and undergoing hysteroscopy for fibroid identification and removal, she achieved a successful pregnancy.

Hysteroscopy unveils the intricate details of the uterine cavity. In this case, it illuminated the presence of myomas, which transvaginal ultrasounds had only partially revealed. The strain ratio, a key indicator of uterine health, was notably elevated, hinting at potential challenges for embryo implantation.

Maintaining optimal vitamin D3 levels is vital in patients with myomas. Vitamin D3 deficiency can exacerbate myoma growth, making its regulation a priority. Ensuring patients have the correct levels of this vitamin can significantly aid treatment.

Case 3: Chronic Endometritis Diagnosis

A 28-year-old patient with a history of failed IVF attempts was diagnosed with chronic endometritis through hysteroscopy. After treatment, she achieved a successful pregnancy.

Chronic endometritis and uterine fibroids can intricately impact fertility. Hysteroscopy played a pivotal role in identifying these issues, including dilated vessels within fibroids, all of which can impede successful pregnancy. Notably, the bipolar resectoscope proved invaluable in treating the uterine cavity.

Conclusion

Hysteroscopy is the gold standard for the evaluation of intrauterine pathology and the condition of the endometrium to identify the causes of infertility and is recommended before assisted reproductive technology programs.

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- Questions and Answers

I have undergone a 4th transfer with a different donor. I had 1 miscarriage and 3 negatives. I plan to do another transfer using ERA. Would you recommend undergoing a hysteroscopy? I am fully completed with menopause, no period since last March 2022.

Yes, I recommend undergoing a hysteroscopy because it will show the presence of chronic endometritis, and you should treat chronic endometritis before a successful embryo transfer. An inflamed uterus can lead to miscarriages or chemical pregnancies instead of a successful pregnancy. Yes, you should definitely do the hysteroscopy even if you haven’t had a period since March 2022. This is not the cause of not doing the hysteroscopy, and it’s important to ensure a healthy uterine cavity.

Is ERA necessary before embryo transfer?

ERA is useful for determining the timing of embryo transfer, and it’s done in combination with hysteroscopy to increase the chances of a successful transfer.

What is the maximum recommended time to do a frozen embryo transfer after hysteroscopy? Is 3 months too long?

If you have a healthy uterus, 3 months after hysteroscopy should be acceptable. However, if there is inflammation, it’s preferable to wait for 2 months after treating it with antibiotics.

If you’ve had 1 hysteroscopy with normal findings and a negative biopsy for chronic endometritis but then had recurrent implantation failures, would you do another hysteroscopy right after 12 months?

It’s a good practice to consult with another doctor and share the video of the hysteroscopy to get a second opinion before deciding on another hysteroscopy.

I had a number of very painful embryo transfers, then had a hysteroscopy, and the next transfer was painless and easy. Will this affect the last one?

Painful embryo transfers can affect the success of the transfer. It’s important to ensure that embryo transfers are as painless as possible to increase the chances of success.

I have two 6BB embryos that I plan to transfer. What is your opinion on the quality of 6BB embryos and the success rates?

6BB embryos are considered good quality, especially if they are day-six blastocysts. Your chances of success should be good if your uterus is healthy and all other factors are favorable.
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Authors
Picture of Dr Viktoria Mokhnii

Dr Viktoria Mokhnii

Dr Viktoria Mokhnii, Gynecologist & Reproductologist at The Ekstramed Reproductive Medicine Clinic (Ivano-Frankivsk, Ukraine). She obtained her Doctor of Medicine degree from Ivano-Frankivsk Medical University in 1996. Following that, she pursued an internship in Obstetrics and Gynecology at Kyiv National Academy of Postgraduate Education from 1996 to 1998. In 2016, Dr. Mokhni further enhanced her expertise in reproductive medicine by completing a specialized course in Reproductive Medicine at P.L. Shupyk National Medical Academy of Postgraduate Education. Recognizing the importance of staying up to date with the latest advancements in her field, Dr. Mokhni participated in a Hysteroscopy Training Program at Kyiv National Academy of Postgraduate Education from 2019 to 2020. This program allowed her to expand her proficiency in diagnostic and therapeutic hysteroscopy procedures. She is a member of ESHRE, ASRM, UARM, EFS, GCH.
Event Moderator
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Caroline Kulczycka

Caroline Kulczycka is managing MyIVFAnswers.com and has been hosting IVFWEBINARS dedicated to patients struggling with infertility since 2020. She's highly motivated and believes that educating patients so that they can make informed decisions is essential in their IVF journey. In the past, she has been working as an International Patient Coordinator, where she was helping and directing patients on their right path. She also worked in the tourism industry, and dealt with international customers on a daily basis, including working abroad. In her free time, you’ll find her travelling, biking, learning new things, or spending time outdoors.
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