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.