Welcome to the Assisted Reproductive Technology series with Dr. Ken. Here, we discuss Assisted Reproductive Technology (ART) as a means to tackling the problem of infertility.In the last session, we answered the century long question of:
AS and AS, can they marry? We went through historic lane and saw that for a very long time, couples of the same gender were vehemently discouraged from getting married on the grounds that it poses the risk of sickle cell disease on their offspring.
We however reflected on the possibility presented by Preimplantation Genetics Diagnosis / Screening. This is an advanced technique in which embryos are screened for genetic abnormalities before transfer ensuring that only healthy embryos are transferred. We ended by saying that with this possibility, AS and AS couple 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 significant 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 suspected. It permits direct visualization of the cavity of the uterus by searching the nature, location, size, shape of any uterine abnormality. Hysteroscopy allows a direct operative intervention in case of any abnormal finding.
Reasons for Hysteroscopy before IVF •
Women with previous endometrial curettage (uterine evacuation following an abortion / miscarriage) •
Women with previous uterine surgeries like myomectomy for fibroid, caesarian section etc. •
Where other investigative modalities like ultrasound or hysterosalpingography created an intrauterine anomaly like polyps or a congenitally abnormal uterus. •
A previously failed IVF treatment Done routinely for all clients before IVF by some practitioners.Even before a hysteroscopy, a clinical evaluation is done to determine what the likely abnormality is.
A drug may be administered transvaginally to soften the cervix to allow easy passage of the hysteroscope. Various modalities 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 depending on the indication and nature of the procedure.Evaluation with hysteroscopy offers an opportunity to diagnose and treat intrauterine pathologies missed by other modalities of investigation.
It is important to note that evidence abound that IVF success rate is increased in women who had pre-IVF hysteroscopy.In conclusion, hysteroscopy represents the second eye of the Reproductive Biologist, and a liberal utilization of this investigative modality to evaluate 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 capacity to deliver on this.
Worthy of mention is Alps Hospitals and Diagnostics, located in Jos, Plateau state Nigeria. 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 Nigeria which you can take advantage of.Until next time, stay fine, and always remember that conception and child bearing is a possibility for everyone that so desires.
Dr. Kenneth Egwuda is a consultant Obstetrician and Gynecologist with 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 Technology (ART) in Nigeria. It holds the record of the oldest first-time delivery mum in Africa through IVF at the age of 63.
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