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การส่องกล้องตรวจโพรงมดลูก Hysteroscopy

Hysteroscopy for Infertility

Why Hysteroscopy?

Hysteroscopy has become increasingly popular among infertility, although there has been an argument whether the procedure should be done before starting embryo transfer or after the failed result comes out.  A study issued in Reproductive biomedicine online, 2014, found that: “Hysteroscopy before IVF increases both the clinical pregnancy rate and the live birth rate”

CPR-Hysteroscopy

The forest plot shows the compared clinical pregnancy rate (CPR) between the groups of patients with and without hysteroscopy. The group with hysteroscopy has a greater clinical pregnancy rate than those without up to 44% (RR 1.44, CI 1.08-1.92).

Who is Hysteroscopy for?

  1. Patients with repeated failure of implantation
  2. Patients with suspected major uterine cavity abnormalities diagnosed by ultrasound such as;
  3. endometrial polyps
  4. Intrauterine adhesions
  5. Submucous myoma uteri
  6. Patients with good quality embryos with recurrent implantation failure (RIF), e.g., three times of unsuccessful pregnancy whether by fresh embryo transfer or frozen embryo transfer, with four good quality embryos to transfer at the least.

Causes of Recurrent Implantation Failure

From a study of 70 women with RIF (three times of unsuccessful embryo transfers at the least) diagnosed by hysteroscopy in 2015, found the possibility of chronic endometritis, which are:

  1. Small endometrial polyps
  2. Irregular endometrial lining and hyperremia

After the treatment with antibiotics, the treated group has significantly higher percentages of clinical pregnancy rate (CPR) (65% vs. 33%, p=0.039) and live birth rate (LBR) (61% vs. 13%, p=0.02) and lower tendency to miscarriage than the group with chronic endometritis. Chronic endometritis adversely affects uterine receptivity resulted in the decreasing of implantation rate. There are many causes of implantation failure, therefore, the complete diagnosis from medical history taking (e.g., abortion, ovarian stimulation, embryo transfers, and the quality of embryo) along with uterus scan and laboratory blood tests are needed to determine the cause of failure.

 


 

Dr. Nattharut Kulphaweesuwan, MD

Dr. Nattharut Kulphaweesuwan, MD

(Obstetrician and Gynecologist Subspecialty in Reproductive Medicine)

For more information please contact

Talk to Dr. Nattharut Kulphaweesuwan

May I reserve the right to reply to inquiries that provide a complete information.