Thursday, November 26, 2015

Why doing hysteroscopy routinely prior to IVF is a bad idea

Many IVF doctors do a hysteroscopy routinely prior to doing an IVF cycle. Their justification is that a healthy endometrium is important to allow embryo implantation and if there is a problem within the uterine cavity, this will reduce IVF success rates by reducing the chances of implantation. Since it's such a simple procedure, then why not do it routinely for everyone before every IVF cycle , to increase the chances of success?

The truth, however, is that this is not a very sensible approach from a patient's point of view. It's good for the IVF doctor , because he just needs to use a check list and mindlessly order the procedure routinely for every patient who comes to them. From their point of view, hysteroscopy is " minimally invasive" , minor surgery. But for a patient, not only is it an additional expense, the very fact that they're required to go into the operation theater can be extremely stressful !

This is why a hysteroscopy should be used selectively , only for patients where the HSG or the scan shows an abnormality. The fact is that for an asymptomatic patient where the endometrial lining is thick and trilaminar  on the vaginal ultrasound scan, the chances of picking up a problem during a hysteroscopy are so low , that it's not justified to subject the patient to a surgical intervention, no matter how minor it is. This is surgery which is likely to provide a very poor yield . Of course, the doctor can justify it by saying that we have now proven that your uterine cavity is normal, but when we can get the same information with a nonivasive ultrasound scan, then is it fair to subject the patient to unnecessary surgery ?

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