Hysteroscopic Surgery
Hysteroscopy is a technique which involves looking inside the uterus with a small telescope type instrument introduced through the cervix, to enable visualisation of the uterine cavity and also the right and left tubal ostea, where the fallopian tubes connect to the main part of the uterine cavity. If the cavity of the uterus appears normal, no surgical procedure is needed. It is usual to take a tissue sample from the lining of the uterus at the time of hysteroscopy, that tissue is evaluated under the microscope. The information obtained can help to ascertain whether or not the stage of development of the endometrium is appropriate for the day of the cycle when the sample was taken, and also to look for any signs of infection. The latter is particularly important because any inflammation of the lining of the uterus will prevent even a healthy embryo from implanting.
Intrauterine Adhesions
This is often called Asherman’s Syndrome. Adhesions can be caused by infection, previous operative procedures (for example removing miscarriage tissue) and sometimes more complex operative procedures such as removing uterine fibroids (myomectomy surgery). Adhesions will greatly reduce a woman’s ability to conceive and in severe cases causes the cavity of the uterus to be extremely small. Adhesions can be divided by a number of techniques. Thin, filmy adhesions will often be broken down by hydrostatic distension. This means expanding the cavity of the uterus using fluid. Dense adhesions, which are thicker, will need dividing at the time of hysteroscopic surgery using a small pair of scissors, or a small instrument connected to either a bipolar or monopolar diathermy machine. The choice of instrument will depend on the extent of the adhesions and the size of the cavity of the uterus. As with polyps, it helps to insert an IUCD or a balloon device post-operatively, to prevent adhesions reforming and it can also help to use Pitressin at the time of surgery to help prevent any bleeding. If the adhesions are very extensive, sometimes a second operative procedure is required.
There's been a recent article on Asherman syndrome which I have reviewed. Click here to read the article