A Womb with a View: Hysteroscopy's Insight into the Embryo's First Home!

Welcome to a revealing episode of 'Taco Bout Fertility Tuesday' - 'A Womb with a View: Hysteroscopy's Insight into the Embryo's First Home!' In this episode, we not only explore the fascinating world of hysteroscopy but also walk you through what to expect during this insightful procedure. From the moment you step into the doctor's office to the post-procedure care, we'll cover it all. Discover how hysteroscopy offers a clear view into the uterus, the all-important sanctuary for an embryo's development. We'll demystify the process, share useful tips, and sprinkle in some humor to keep things light. So whether you're curious, anxious, or just looking to learn, tune in for an episode that promises to enlighten and entertain in equal measure!"

Thanks for tuning in to another episode of 'Taco Bout Fertility Tuesday' with Dr. Mark Amols. If you found this episode insightful, please share it with friends and family who might benefit from our discussion. Remember, your feedback is invaluable to us – leave us a review on Apple Podcasts, Spotify, or your preferred listening platform.

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Join us next Tuesday for more discussions on fertility, where we blend medical expertise with a touch of humor to make complex topics accessible and engaging. Until then, keep the conversation going and remember: understanding your fertility is a journey we're on together.

Transcript

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During your workup, it's very possible that they may have found a polyp or a fibroid. Both of these are intrauterine pathology that can affect your chances when getting pregnant. Sometimes you need to surgically remove them. Sometimes you just need another diagnostic test to verify it. So your doctor will either recommend a diagnostic hysteroscopy or an operative hysteroscopy. And today we talk about hysteroscopy and what to expect at your planned procedure. I'm, Dr. Mark Amos, and this is taco, about fertility Tuesday. Now, the type of test that can determine if you have intrauterine pathology is going to be either a saline sono infusion gram, also called an SHG, or you could even have a diagnostic hysteroscopy. Now, a diagnostic hysteroscopy is where they. Put a camera into your uterus to look to see if there's something in there. But an operative hysteroscopy is where they actually do something about it. The question is, why would they do something at the same time? Well, because sometimes some of these cameras are not meant to do surgery. They're just there to diagnose a problem. And so in a diagnostic hysteroscopy, they. May be able to, in the room, tell there's something there. But they need to use a surgical. Operative hysteroscopy to be able to treat it. With a sonohistram, they're never going to be able to treat because that's just filling up the uterus with water and then looking to see if anything is creating a filling defect. In either situation, you're going to need at least another hysteroscopy. Now, I feel like I'm dating myself. But I can tell you, hysteroscopy has. Come a long way. When I started my residency and started. Training, I was just beginning when things started to advance. But prior to my residency, they only. Were able to look with a camera. Into this uterus using a very large scope, and they couldn't do any surgery. So then what they would have to. Do is blindly place something into the uterus and try to pull it out. And then they would look again and see if they got it. And if they didn't, they'd do it over and over and over until they finally got it. And there was a risk for complications, because sometimes that device, they would go too far through the top of uterus and grab things like the bowel or other things. And there was no way for them to know it until they pulled it out and realized they grabbed something else. So when I started reddency, they started being able to make a small port. Through the camera and then be able. To do surgery with that. Now, at first, it was only small surgeries. You could do, like little polyps, but. Then we were able to remove things like fibroids. And eventually these cameras have got so small now that the actual entire device could be as small as 6. Through that, we can see everything and do surgeries. There are many things you can use hysteroscopy for. It's not just for fertility surgeries, but in our area. The main areas we're going to use. It is to remove polyps, called a. Hysteroscopic polypectomy, or to remove fibroids, called a hysteroscopic myomeectomy. However, just for your own knowledge, you. Can use hysteroscopy to even cause ablations, which burns the inside of the uterus. For people who have heavy periods, you. Can even do surgeries where you can stick electrodes into fibroids and even kill those fibroids. For people who have very heavy periods. With fibroids, it can even be used for a DNC when someone has a. Failed pregnancy and doesn't want to take. The risk of scarring. With a normal method, they can use a camera and go in there and carefully remove the pregnancy with less trauma. To the surrounding area. In the end, as you can see, there are multiple uses for hysteroscopy, but. We'Re going to focus on three of them. Those are going to be one, removing. Polyps, two, removing fibroids, and three, removing. Products of conception after a failed pregnancy. What's interesting is a hysteroscopy can be. Performed in the clinic if the risk is low. Otherwise, it usually is done at a hospital. For uterine polyps, the risk is so. Small that they can be performed in an office. That's because the polyp doesn't have a very big blood supply. Matter of fact, when you are removing the tissue, you're only removing the tissue. In the endometrium, which is the same. Tissue that you pass when you have a menstrual cycle. So the risk of heavy bleeding is very, very low. However, when it comes to removing fibroids. You'Re actually going into the muscle, and in that situation, you can bleed much more. And, for that reason, you need to be in the hospital just in case there are any complications, or if there is concern of heavy bleeding, you can actually do something about it. Now, keep in mind, some clinics do have outpatient amateur surgical centers attached to them. So even though it may feel like. You'Re at the clinic, you are still. In a safe place doing your surgery. When it comes to hysteroscopy for removal, proxy conception, it's going to depend a. Little bit about what you're removing. If someone has something, let's say, leftover prox conception, that could possibly be done in office. But if you're talking about a pregnancy that is definitely further along, that really should be done at either an amateur surgical center or the hospital, again, because of concerns of, potential bleeding and complications. Now, one of the things to understand is a hysteroscopy is a camera inside the uterus. That means we can see the openings of the fallopian tubes, but we can't see the fallopian tubes, so we can't tell you anything about if they're functional. Or if they're open. Additionally, we can't see outside of the uterus because we're inside the cavity. So you can't see things like endometriosis or things that are inside the pelvis. It is just an image of the inside of the uterus and going through the cervix. Now, if you are doing this as. A diagnostic procedure, then what you would do is you would go in with. The histoscope, and you would look around. To diagnose if someone does have polyps. Fibroids, adhesions, like scar tissues, and other things. If you're doing as an operative procedure, then you're going in to repair those things, such as removing palms, fibroids, and removing adhesions. Adhesions are scar tissue that can be inside the cavity, and those should almost always be done in the hospital as. Well, due to heavy bleeding. Whether you're doing this in the clinic or doing it at a surgical center. There'S usually going to be some preparatory phase. That's going to be whether that's not eating or drinking past midnight or emptying your bladder, getting an iv, you'll come. To the place beforehand. At clinics, it's going to be much shorter. In the hospital. It's going to be much longer eventually. Once all the prep stuff is done, you've met the anesthesiologist. You'll be brought to the operating room. Where then the procedure will be performed. Now, you will be asleep for this. Procedure, and you'll usually undergo general anesthesia. Your legs are usually going to be put in a stirrup, so that way they have easy access to the vagina to be able to then get into the uterus. The procedure usually starts with some type of preparation that's going to be cleaning off the area with iodine or some type of cleaning solution to prevent infections. Then what will happen is they'll put. A little device on the cervix to hold it in place. Otherwise your uterus will move freely and you don't want the uterus moving when you have a camera in it. So instead they put a device called a tenaculum. That does look a little medieval in. A way, but it holds the cervix in place so the camera can go. Through without the uterus moving. Then usually you will be dilated, meaning. The cervix is widened a tiny bit to allow the camera to go through. Now, with these newer scopes that are very, very small, you don't have to. Do this as much, but sometimes you. Do have to dilate a little bit. Because as you would expect, God never. Intended the camera to go in your uterus. So we have to open it up a little bit. Then the camera, with saline being fused. Through it, enters the vagina through the. Cervix and goes into the uterine cavity. And this is an important step because. When we get in there, we have. To verify where we are. Now, for most uteruses that don't have scarring, it's pretty obvious. You get in there, you know, you're in the uterus. And the way you verify is by looking for the osteo, which are the openings to the fallopian tube. Now, at first it seems pretty obvious, like, of course, you're in the uterus, why would you not be? You went through the cervix. But actually, when people have severe scarring in their uterus, which is a syndrome. Called Asherman syndrome, there are times that. You can be in what's called a false passage, where you actually dilated an empty space. And you'll get in there and you'll. Notice there's not openings for the fallopian tubes. And so you may be in the wrong spot. And this is how you're able to determine it. Sometimes in Asherman syndrome, it is so severe that they'll actually do a laparoscopy, putting a camera in your belly to be able to make sure they're in the right location so they're not going through the top of your uterus or anything like that. Once we verify where we are, then at that point they'll remove the polyps. There's multiple ways this can be done. You can use what are called graspers. That go in there and remove the polyp. You can actually use a morsilator that will cut the polyp out very rapidly. There's even loops that you can put. Around polyps and pull them out, and. Then you can even use scissors and cut them and then remove them. Now, fibroids are a little bit different. With fibroids, you're going to have to use a morsilator, because it would be very difficult to just pull a fibroid out. Usually have to cut into the tissue, and there are multiple morsilators out there. It'd be too much to go through in just this podcast. But the point is they use a. Device that goes through the camera that. Can then remove the fibroid. The goal, obviously is to clean out the cavity, removing the polyps, removing the fibroids. You have a nice normal cavity. Now, if it's after adhesions, usually you. Use scissors that can then go and cut down the adhesions, and then you usually clean the area by either using. A morselator or another device to take. Down some of those adhesions. Eventually everything is removed. At that point you're done with the procedure. You will then remove the camera from the uterus, from the cervix, through the vagina. Then you will remove the tenaculum m. Off the cervix and end the procedure. All of the tissue that was removed. Will be sent off to a pathologist just to be sure. There's nothing abnormal about that tissue. Sometimes there's some minor bleeding, and we. Have to stop that bleeding by using. Either a solution called silver nitrate, or with pressure to stop the bleeding from the tip of the cervix, where we put the tenaculum. The mild amount of bleeding that comes. Through the cervix from being in the. Uterus is very mild and usually stops. If it doesn't stop, there are maneuvers. We can do to reduce the bleeding. Once the procedure is over, then you're taken to the recovery area where you. Will then awake and be given medication for discomfort. Now, there is some discomfort, and the discomforts can be a little different than like, let's say if you had a. Cut on your abdomen, since there's no. Incisions here and everything's so natural orifices. There'S no actual cuts on you. But just like with a period, you. Can have severe discomfort from your uterus cramping. And that's usually what people feel, depending. On how involved the surgery is, that cramping can be more severe than other surgeries usually the best treatment is going. To be ibuprofen or toridol, and sometimes. Even pain meds if needed. But usually once the cramping stops, most. Of the discomfort is gone. Because this procedure is using natural orifices and there's no incisions, the recovery is very fast. If you have a polypectomy, then basically. As soon as you have a period, your uterus is back to normal because you shed the lining that we were working on. So there's nothing even left from the. Prior lining before you start treatment or whatever you plan to do now with. The fibroid, it's a little bit different. Depending on how severe the fibroid was. With regards to transversing the myometrium, which is the muscle in the uterus, and how much tissue had to be removed, it may be recommended by your surgeon to wait some time before trying to get pregnant. The same goes with an asherman syndrome. When you have scarring, there are times. That we'll actually put a device in the uterus to keep it open, put you on estrogen to allow it to heal before starting to try to get pregnant. But with polyps, it's actually pretty fast. And within the next period, you can go and get pregnant again. When it comes to recovery, we generally recommend nothing in the vagina for about three to seven days. But you can go back to your. Normal activities the next day because, again, this is a natural orifice surgery. So there's no incisions, so there's very little when it comes to restrictions. One of the questions comes up is why would a pulp or fibroid cause a problem? Well, because it's in the cavity. And so imagine that cavity is the. Home for your baby. And so if a fibroid is in there, it's very large. It can actually start to create inflammation, just like a polyp that can then prevent implantation. Matter of fact, that's how an IUD works. The IUD works by creating inflammation inside of the uterus and the inflammatory response of the body. Trying to get rid of the IUD creates an environment that prevents implantation. I remember a couple of patients that I've had who have had very large polyps. And when I say large, I'm seeing as big as a pinky or even. As big as my thumb. And the uterine cavity is only as. Big as my thumb. And so it was taking up somewhere between 90% to 70% of the cavity. And when I saw them, we found. This, we treated it, and then both. Of them got pregnant the next month. Just trying on their own. Now, when both of these pulps came. Out and the pathologist saw them, they were both very inflamed, which showed that. There was some type of inflammation inside the urine cavity trying to tack these polyps, which was probably creating the environment, preventing pregnancy. Now, when it comes to IVF patients, sometimes small polyps that can go away. On their own will still remove, not. Because they won't go away, but because someone might not want to wait six to nine months or even a year for it to come out on its own, and so instead would rather just. Do the surgery to remove it so they can try faster. It's important to remember that when we talk about these scenarios, we're talking about from a fertility perspective. Again, someone trying to remove fibroids for. Other reasons will have different options and will have different risk. We are specifically talking about fibroids that. Are in the cavity. We are talking about polyps that are. Inside the uterine cavity and scar tissue inside the uterine cavity. People can have other things such as fibroids that transcend through the m myometrium, fibroids that can be on the outside. Of the uterus, and even scar tissue. That can be in other places. But we are not talking about them. We're just talking about with regards to fertility, hopefully during your workup you haven't found any type of intrauterine filling defects that they think might be polyps or fibroids or even scar tissue. But if you did, hopefully this episode was helpful to you. And even if your friend had this happen, tell them about this episode and maybe they can learn a lot about it. As always, I greatly appreciate everyone that listens to the podcast, and I appreciate you sharing it with your friends and giving us good reviews. As always, I look forward to talking you again next week on talk about fertility Tuesday.