Tuesday, February 11, 2014

Why you should not do routine hysteroscopy before IVF

Many IVF specialists perform hysteroscopy routinely for all patients who are undergoing IVF treatment . I think this is a big mistake .

Now I understand why hysteroscopy is recommended. In order to achieve an IVF  pregnancy , the doctor needs good eggs; a few sperm; and a normal uterine cavity. Hysteroscopy is a very effective way of evaluating whether the cavity is normal or not – and is considered to be the gold standard for this indication. Hysteroscopy is a simple and relatively inexpensive procedure , which does not require hospitalization. From the doctor’s perspective , it’s a “ minor “ procedure , which is why they are happy to do it for everyone who comes to them. After all, they need to be thorough and meticulous in their evaluation !

Sadly, no procedure is ever minor for the patient – and they still do need to spend out of their pocket for this surgery. The fact is that most routine hysteroscopies done prior to IVF turn out to be completely normal – which means the procedure was never needed in the first place, because it did not provide any useful information for that particular patient, and did not change their treatment plan at all. While patients are very happy that the results are normal, the truth is that they wasted time and money in doing unnecessary surgery.

A simple rule in medicine is that if we can get the information we need by doing noninvasive tests , then it’s not justifiable to do a surgical procedure to get that same information . Noninvasive tests are much simpler, kinder, easier and cheaper ! Thus, if a vaginal ultrasound scan shows that the patient has a trilaminar thick uterine lining , we know that the hysteroscopy is going to be normal, and there’s really no point in doing at all ( except to maximize the doctor’s profits).

Ideally, IVF doctors should do hysteroscopy selectively – only for patients whose endometrium is abnormal on the vaginal ultrasound scan . This makes sense, because the chances of finding an abnormality are much higher in this small group. It is not a good idea to mindlessly subject a lot of patients to an unnecessary surgical procedure , simply because it is part of the IVF clinic protocol !

What may be profitable for the doctor is definitely not in the patient's best interests . If the doctor advises you to have a hysteroscopy , you should push back and ask he first perform a vaginal ultrasound scan to check your uterine lining. If this is normal – especially with the new digital high resolution 3D vaginal ultrasound scanners available today, then there’s no point in doing a hysteroscopy at all.

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