Page 3 - World Journal of Laparoscopic Surgery

REVIEW ARTICLE Hysteroscopy and Assisted Reproductive Technology

Hysteroscopy and Assisted Reproductive

Technology

Bamgbopa Tajudeen Kehinde
Nordica Fertility Center Lagos, Nigeria-106/108, Norman Williams Street, Ikoyi, Lagos, Nigeria

Abstract
Introduction: Hysteroscopy is an excellent instrument for evaluating the uterine characteristics in infertile women. It is the gold standard
in the assessment of uterine anomalies today.
The aim: This review examines the two main applications of hysteroscopy in infertile patients who are candidates for assisted
reproductive techniques: (1) In the evaluation the cervix, uterine cavity and rule out any pathology or lesions that could have been
missed by hysterosalpingography or sonohysterography (2) Hysteroscopic surgery as treatment for uterine abnormalities in infertile
patient going for assisted reproduction.
Methods: A literature search was conducted using Medline, Pubmed, Springer link and Highwire press. The following search terms were
used: hysteroscopy, fertility, assisted reproduction, ART, IVF. Article were carefully selected and reviewed.
Results: There is a paucity of publications specifically on hysteroscopy use in ART, particularly from the third world. The Prevalence of
uterine anomalies in women planned for ART is significant, necessitating a comprehensive assessment before ART treatment. Office
hysteroscopy is a safe, effective and widely acceptable tool in the primary investigation of couple planned for ART. Hysteroscopic
surgery is the mainstay of treatment of uterine anomalies in assisted reproduction and is a safe and effective alternative to laparoscopic
salpingectomy in patients with hydrosalpinges.
Conclusion: The applications of hysteroscopy in assisted reproduction are still rapidly evolving. There are, however many areas of
hysteroscopy in ART which require more research to enable the adoption of best practices in assisted reproduction.
Keywords: Hysteroscopy, assisted reproduction, infertility.

INTRODUCTION There is a growing consensus towards its use in the primary
investigation of infertile women prior to in vitro Fertilization, 2,4,6
Anomalies within the uterine cavity play an important role in as well as in the management of hydrosalpinges in such patients,
fertility because they are capable of interfering with implantation. in place of laparoscopy. 7-9
Adhesions, septa, polyps, submucous myomas, adenomyosis, In this review, an attempt is made to examine the various
endometritis, anomalies of the cervical canal, and lesions of the applications of hysteroscopy in assisted reproduction in recent
uterotubal junction are uterine disorders most often observed published literature, with particular focus on its use in primary
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during investigation of and are implicated in infertility. The assessment before IVF, assessment after repeat IVF failures as
proper diagnosis and treatment of these anomalies is vital to well as the uses of hysteroscopic surgery in assisted
achieving success in assisted reproduction. reproductive technology.
Hysterosalpingography can be used to evaluate tubal
permeability but provides inadequate information about the MATERIAL AND METHODS
uterine cavity (numerous false-positives and false-negatives)
and pelvic ultrasound is especially helpful for diagnosing A literature search was conducted using Medline, Pubmed ,
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interstitial anomalies in the uterus. Hysteroscopy, however, Springer link and Highwire press. The following search terms
allows direct visualization of the uterine cavity, the endometrial were used: Hysteroscopy, fertility, assisted reproduction, ART,
mucus (and the cervical canal). The examination maybe practiced IVF. In this review, ART include any form of assisted
on an out-patient basis, without anesthesia, using appropriate reproduction, including IVF/ICSI and ovarian stimulation with
small-caliber instruments and irrigation with physiological or without artificial insemination.
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saline. It may be necessary as a first line investigation because Abstracts had to be written in English and if the abstract
a significant percentage of patients have uterine pathology was pertinent and relevant to the topic, the full article whether
that may impair the success of fertility treatment. 3-5 in English, German or French was sought. Other sources include
Hysteroscopic treatment of these anomalies is also possible at Google using the same keywords and the websites of different
the same time. 1,6 organizations, such as ESHRE, IFFS, and FIGO, etc.
The role of hysteroscopy in assisted reproduction has There were 1456 citations in total. Selected publications
expanded over the years and the applications are still evolving. were screened for further references. Criteria for selection of
World Journal of Laparoscopic Surgery, September-December 2009;2(3):1-9 1