Endoscopic Procedures for IVF
Since failure of IVF treatment is a mental, physical and financial disaster, every effort must be made to maximize the chances of success in an IVF treatment. Maximum success is possible by thorough preparation of the couple prior to undertaking treatment. It is vital to define the exact cause of the infertility and to explain this to the couple along with the possible treatment options. Various tests are available which include blood tests of the couple, semen tests, ultra-sonography, and Endoscopy.
Endoscopy means looking inside and typically refers to looking inside the body for medical reasons using an endoscope, a fibreoptic instrument used to examine the interior of a hollow organ or cavity of the body.
There are varying types of endoscopic procedures and usually are named after the cavity or hollow organ being investigated. However, the ones commonly used in gynaecological cases are Hysteroscopy and Laparoscopy.
Hysteroscopy is conducted under general anaesthesia. This enables diagnosis and at the same time, surgical improvement of the womb is also possible. It helps in detecting abnormalities at the neck of the womb, which can affect the procedure of embryo transfer. It can remove abnormalities inside the womb such as polyps, fibroids, adhesions and even womb defects from birth (Septum). These abnormalities not only decrease the success of IVF but, can also lead to miscarriages. The lining of the womb is an important factor affecting the success of IVF, and can be evaluated at this time.
The hysteroscopy is followed by gentle curetting (scraping) of the lining of the womb. This is sent for microscopic assessment to the pathology department. Infection and hormonal abnormalities in the lining of the womb can be diagnosed and then treated, thereby improving the success of IVF.
The massive benefit offered by the hysteroscopy makes it almost mandatory in every patient before IVF and certainly in patients with repeated IVF failures and recurrent miscarriages. The procedure does not involve any cut on the stomach, nor any pain and is performed as an out-patient, single-day procedure.
Laparoscopy, a minimally invasive procedure or keyhole procedure, is a modern surgical technique in which operations are performed far from their location through small incisions (usually 0.5–1.5 cm) elsewhere in the body. It is used to find problems such as cysts, adhesions, fibroids and infection. Tissue samples can be taken for biopsy through the tube (laparoscope).
Benefits Of Endoscopy In IVF
- To diagnose tubal factor infertility especially when used with a dye test.
- To remove adhesion bands around the tubes and or ovaries.
- To remove or burn off endometriosis deposits anywhere found; tubes, ovaries, cu-de-sac, etc., whenever possible.
- Sometimes to treat anovulation due to a polycystic Ovarian Syndrome (PCOS) by drilling holes in the ovaries.
- In certain circumstances for Oocyte (egg) retrieval.
- Sometimes to remove fibroids.
- Quicker recovery and better satisfaction.
The procedure is usually done in the hospital or outpatient surgical centre under general anaesthesia (while you are asleep and pain-free). However, very rarely, this procedure may also be done using local anaesthesia. This numbs only the area affected by the surgery and allows you to stay awake.
A surgeon makes a small cut below the belly button (navel) and inserts a needle into the area. Carbon dioxide gas is passed into the abdomen to expand the area. This gives the surgeon more room to work, and helps the surgeon see the organs more clearly.
A tube is placed through the cut in your abdomen. A tiny video camera (laparoscope) goes through this tube and is used to see the inside of the pelvis and abdomen. More small cuts may be made if other instruments are needed to get a better view of certain organs.
If you are having gynaecologic laparoscopy, dye may be injected into your cervix area so the surgeon can better see your fallopian tubes.
After the exam, the gas, laparoscope, and instruments are removed, and the cuts are closed. You will have bandages over those areas.
As with any surgery, there is a small risk of problems with laparoscopy. These risks include:
- Bleeding or hernia in the incision sites
- Internal bleeding
- Injury to internal organs
- Problems caused by anaesthesia. However, these risks are minimal in the hands of experienced surgeons