Every effort must be made to maximize the chances of success in an IVF treatment. Failure of IVF treatment is a mental, physical and financial disaster. 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, ultrasonography and endoscopy. Endoscopy includes Laparoscopy and Hysteroscopy.
The role of Hysteroscopy in the success of IVF
A 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.
This 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 on a day care base. In India, this can cost as little as £300.
Improving IVF success rates with Laparoscopy
A Laparoscopy involves putting a telescope measuring 5 to 10 mm in diameter through the navel into the stomach. This helps us to visualise the reproductive organs (including the uterus, the fallopian tubes, the ovaries and the rest of the pelvis and abdomen) on the screen. Additionally, three small cuts of 5mm length may be required on the stomach to insert other instruments that are needed during the laparoscopy procedure.
Proper transvaginal sonography is crucial to diagnose tubal disease, ovarian abnormalities, uterine factors and other pelvic abnormalities that can adversely affect an IVF cycle. Tubal disease includes infections that lead to the fluid collection within the tubes (hydrosalpinx), the ovaries may have cysts and the uterus may have fibroids and polyps.
If the ultrasonography has detected any of the above abnormalities, a laparoscopy becomes necessary to improve the outcome of the IVF cycle. If the tubes are infected and filled with fluid, they have to be disconnected from the uterus. If not, the unhealthy fluid can prevent the implantation of embryos in the cavity of the womb. It is important to ensure that both ovaries are free and located normally so that they are well accessible for the egg collection procedure.
Ovaries can be adherent due to adhesions resulting from conditions such as endometriosis, pelvic infections and previous surgeries. In these situations, a laparoscopy can help in the breakdown of these adhesions and free the ovaries. Before starting an IVF cycle, cysts in the ovaries need to be removed. These could be simple cysts, endometriotic cysts or even complex cysts such as dermoids. This improves the success of the IVF treatment. If the uterus has fibroids which are large (>4cm) and if they are located within the cavity or near the lining of the womb, then it may be advisable to remove them.
These advanced procedures need special skills and are only performed in highly specialised units. Most women recover quickly from this procedure and are well and mobile within 48 hours. The majority of women are able to go home the next day. Major surgical procedures may need an extra few days for a full recovery. A slight discomfort maybe felt in the stomach for the first few days after the operation.
A laparoscopy is a very commonly performed operation, but possible complications can include: bowel injury, bladder injury and vessel injury. These are very rare complications that affect less than 1 in 1000 patients. Complications are increased in patients with risk factors such as previous surgery with a midline vertical incision or repeated previous abdominal surgery.
The hysteroscopy procedure is useful for almost all patients undergoing IVF treatment, but a laparoscopy is only needed in certain circumstances. With the help of modern technology, improved instrumentation, better imaging systems and more reliable energy sources, the chances of having a successful IVF treatment is greatly improved.
By Dr. Mane of The Origin International Fertility Centre