There is a simple, often-missed clinical step that can make the difference between a failed IVF cycle and a successful pregnancy. It takes fifteen to twenty minutes. It is performed as an outpatient procedure under light sedation. It causes minimal discomfort and requires at most a day of rest. And yet it is not performed routinely at many IVF clinics \u2014 either because it adds a step to the treatment process, or because the ultrasound that was done did not show anything abnormal and the assumption is therefore made that the uterine cavity is normal.<\/p>\n\n\n\n
That assumption is wrong in a surprisingly large proportion of cases.<\/p>\n\n\n\n
Studies consistently show that intrauterine pathology \u2014 endometrial polyps, small submucosal fibroids, uterine septa, or intrauterine adhesions \u2014 is present in 15 to 40 percent of women presenting for their first IVF cycle. The majority of these abnormalities are not reliably visible on standard transvaginal ultrasound. They are only identified by hysteroscopy \u2014 direct visual inspection of the uterine cavity.<\/p>\n\n\n\n
What do these abnormalities do to IVF outcomes? Endometrial polyps and submucosal fibroids distort the uterine cavity and create an environment that impairs embryo implantation. Uterine septa are associated with implantation failure and miscarriage. Intrauterine adhesions reduce the available surface area for implantation and alter the endometrial environment. In studies comparing IVF outcomes in women with untreated intrauterine pathology versus those who had hysteroscopic correction before their first cycle, the groups with corrected pathology have significantly higher implantation and clinical pregnancy rates.<\/p>\n\n\n\n
Dr. Krishnakumar has been performing diagnostic hysteroscopy before first IVF cycles as part of his standard clinical practice for many years \u2014 long before it became a widely discussed recommendation in the international fertility literature. The clinical experience that informs this practice is backed by over 75,000 endoscopic procedures and by outcomes data from thousands of patients at his clinic. When a small polyp is identified and removed in a fifteen-minute hysteroscopy, and the patient goes on to conceive in her first IVF cycle when she had previously had failed cycles elsewhere without hysteroscopy, the value of this step is undeniable.<\/p>\n\n\n\n
If you are planning an IVF cycle and have not yet had a diagnostic hysteroscopy, ask your doctor about it at your next consultation. If you have had failed cycles without one, ask specifically whether intrauterine pathology may have been a contributing factor. The answer may change your treatment plan \u2014 and your outcome.<\/p>\n","protected":false},"excerpt":{"rendered":"
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