Hanadi A. Ba Akdah, MD Consultant, OB-GYN/IVF/ Gynecological Laparoscopy Director, Assisted Reproductive Technology Unit With the advent of medical fiberoptics, diagnostic tools for gynecologic endoscopy were applied not only in intraperitoneal visualization, but also in the visualization of the inside of the uterus (womb); which is known as "Hysteroscopy". Hysteroscopy is carried out using a hysteroscope, which is a narrow tube with a telescope at the end in which Images are sent to a computer in order to get a close-up of the womb. The new hysteroscope is a major advancement in the field of gynecologic endoscopy; it has proven efficiency in a large number of women health centers around the world. It is considered the finest and smallest endoscopes in the world; since it allows doctors to diagnose and treat at the same time. In the past, doctors used to dilate cervix using a (5 mm diameter) hysteroscope in order to gain entry into the uterine cavity and allow a clear visualization; therefore it was painful. Nowadays, new hysteroscope; which is only (2 mm diameter) needs neither dilation nor anesthesia; furthermore many of patients can be treated as outpatients saving time and costs. This new non-invasive technology is strongly recommended as it provides high resolution and exceptional images quality from inside womb and directly through vagina. According to her, there are two main types of the hysteroscopy; one is diagnostic and the other is operative, however both can be used for the following cases: 1 - Infertility and Delayed Pregnancy: to diagnose intrauterine filling defects and unexplained infertility. Using hysteroscope in removing polyps & submucous fibroids (which have been implicated as causes of infertility) may increase chances of getting pregnant. 2 - Recurrent Miscarriages: doctors find out the causes of miscarriages (e.g. uterine septum) which can be directly repaired. 3 - Intrauterine Adhesions: It is one of the reasons behind delayed pregnancy. It could occur as a result of recurrent dilation and curettage. Hysteroscopy can also help to restore normal menses in 88 to 98 % of patients if no other problems. 79% of treated patients get pregnant. 4 - Abnormal Uterine Bleeding: hysteroscopy replaced dilatation and curettage by offering direct visualization, treatment and biopsy for diagnosis. It's very effective in identifying polyp, submucous fibroid and endometrial cancer. Other use is endometrial ablation if infertility not desired as an alternative to hysterectomy.
