elcome to the As-
sisted Reproduc-
tive Technology
series with Dr. Ken.
Here, we discuss Assisted Re-
productive Technology (ART)
as a means to tackle the problem
of infertility.
In the last session, we an-
swered the century-long ques-
tion, AS and AS: Can they
marry? We went through a
historic lane and saw that for a
very long time, couples of the
same gender were vehemently
discouraged from getting mar-
ried on the grounds that it poses
the risk of sickle cell disease to
their offspring.
We however reflected on the
possibility presented by Preim-
plantation Genetics Diagnosis /
Screening. This is an advanced
technique in which embryos
are screened for genetic abnor-
malities before transfer ensur-
ing that only healthy embryos
are transferred. We ended by
saying that with this possibili-
ty, AS and AS couples can freely
get married.
Today we are considering
the IVF procedure and as the
topic implies, we are looking
at the need for Hysteroscopy
before IVF treatment.
Hysteroscopy plays a signifi-
cant role during the preparation
for Invitro fertilization (IVF).
This is a procedure in which a
telescope (Hysteroscope) is used
to visualize the uterine cavity.
Hysteroscopy is the gold
standard for the investigation
of the uterine cavity especially
when an abnormality is sus-
pected. It permits direct visu-
alization of the cavity of the
uterus by searching the nature,
location, size, and shape of any
uterine abnormality. Hysteros-
copy allows a direct operative
intervention in case of any ab-
normal findings.
Reasons for Hysteroscopy before
IVF

• Women with previous en-
  dometrial curettage (uterine
  evacuation following an abor-
  tion/miscarriage)
• Women with previous uter-
  ine surgeries like myomectomy
  for fibroid, caesarian section,
  etc.
• Where other investigative
  modalities like ultrasound or
  hysterosalpingography creat-
  ed an intrauterine anomaly
  like polyps or a congenitally
  abnormal uterus.
• A previously failed IVF
  treatment
• Done routinely for all cli-
  ents before IVF by some prac-
  titioners.
  Even before a hysteroscopy,
  a clinical evaluation is done to
  determine what the likely ab-
  normality is.
  A drug may be administered
  transvaginally to soften the cer-
  vix to allow easy passage of the
  hysteroscope. Various modali-
  ties for pain relief (anesthesia)
  may be employed- local block,
  sedation, regional anesthesia,
  or general anesthesia.
  A video recording of the
  procedure is saved for further
  discussion with the patient and
  future reference.
  Hysteroscopy typically last
  10-45 or more minutes depend-
  ing on the indication and nature
  of the procedure.
  Evaluation with hysteros-
  copy offers an opportunity to
  diagnose and treat intrauterine
  pathologies missed by other mo-
  dalities of investigation.
  It is important to note that
  evidence abounds that the IVF
  success rate is increased in
  women who had pre-IVF hys-
  teroscopy.
  In conclusion, hysterosco-
  py represents the second eye
  of the Reproductive Biologist,
  and a liberal utilization of this
  investigative modality to evalu-
  ate IVF clients.
  While it is now established
  that hysteroscopy before IVF
  might just be a necessary move,
  it is also important to note that
  very few fertility centers in the
  country have attained the ca-
  pacity to deliver on this.
  Worthy of mention is Alps
  Hospitals and Diagnostics, lo-
  cated in Jos, Plateau State Ni-
  geria. This is the first fertility
  center in West Africa to adopt
  the use of laser energy in office
  hysteroscopy. This offers the
  benefits of increased operation
  time, less bloodlessness, and low
  fluid overload.
  Indeed, a lot of possibilities
  in Reproductive Health and
  Medicine abound here in Nige-
  ria which you can take advan-
  tage of.
  Until next time, stay fine,
  and always remember that
  conception and childbearing a
  possibilities for everyone who
  so desires.
  Dr. Kenneth Egwuda is a consultant
  Obstetrician and Gynecologist with
  a specialty in Assisted Reproductive
  Technology (ART). He has over 16
  years of practice and experience. He
  trained in the UK, India, Bulgaria,
  Italy, and Germany. His Facility,
  ALPS Hospitals and Diagnostics,
  Jos, Nigeria, stands at the center
  stage of Assisted Reproductive Tech-
  nology (ART) in Nigeria. It holds the
  record of the oldest first-time delivery
  mum in Africa through IVF at the
  age of 63.
  For more info, visit

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