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We tell you about the latest advances in reproductive medicine.
– Find and conquer! Under this motto, for more than 20 years we have been dealing with the diagnosis and treatment of the causes of infertility. Thanks to the endoscopic techniques of office hysteroscopy, fertiloscopy and laparoscopy, the duration of the examination was reduced to 1-2 days.
Long-term schemes of examination and treatment are already in the past, but before the examination took 3-6 months, in some cases it took years (for example, measuring the temperature in the rectum every day for 3 months, or an uninformative method of checking the fallopian tubes – hysterosalpingography, used in some clinics now).
With the widespread use of endoscopy, the diagnosis has become accurate and specific, the causes in most cases can be eliminated. The effectiveness of infertility treatment by all methods, including IVF, is maximal only when the causes are eliminated, not to mention the fact that pregnancy itself often occurs within 1-6 months after endoscopic treatment.
To see the cause of infertility, for example, endometriosis, adhesions on the fallopian tubes, adhesions inside the uterus, abnormal formation of the uterus (malformations: infantile, saddle-shaped, T-shaped uterus, a small septum inside the uterus), it is possible using only visual examination – hysteroscopy (examination of the cavity uterus), fertiloscopy and laparoscopy (examination of the pelvic organs with a thin video camera).
Let’s understand the terms and indications.
Hysteroscopy – examination of the uterine cavity using an ultra-thin video camera. For more than 15 years in the infertility clinic, we have been using the office version of hysteroscopy: without dilating the cervical canal with metal dilators (as in traditional hysteroscopy), without tensioning the cervix with bullet forceps, an endoscope (camera) is inserted into the cavity under vision control. The examination is painless and often does not require any pain relief.
Office hysteroscopy allows you to see and evaluate the uterus as it is. To see the slightest deviations from the norm, adhesions, deformation of the cavity by myoma nodes, a septum, evaluate a niche after a cesarean section, polyps (even small ones that are not visible on ultrasound), a T-shaped, infantile and saddle uterus, endometriosis of the uterus, signs of chronic endometritis.
In many clinics, office hysteroscopy is also performed before IVF, when it is important to understand the state of the uterus before embryo transfer.
Fertiloscopy – a method that combines hysteroscopy without dilating the cervical canal and examination of the pelvic organs through a vaginal puncture. As a rule, the research is carried out on healthy women suffering from infertility. It was this method that formed the basis of the principle of “examination in one day”. The endoscope allows you to see the pathology in the uterine cavity, and personally examine the fallopian tubes, check their patency, examine the ovaries, the peritoneum of the small pelvis. Fertiloscopy is a highly informative method for diagnosing small forms of endometriosis, peritubar adhesions and those cases when ultrasound is powerless in identifying the causes of infertility.
Laparoscopy – a method of diagnostics and treatment of pathology of the pelvic organs and abdominal cavity. It is the “gold standard” of treatment in identifying conditions (diseases) requiring surgery.
With infertility, this is often the only way to restore fertility or prepare the patient for IVF. For example, with obstruction of the fallopian tubes – the presence of hydrosalpinx – the effectiveness of IVF tends to zero, and after removal of the pathologically altered fallopian tube before IVF, the percentage of pregnancy can reach 40-45%.
But to say that laparoscopy is an operation through small punctures of the abdominal wall means to say nothing.
In modern conditions, laparoscopy not only makes it possible to identify and immediately eliminate pathology, restoring the possibility of independent conception, but also allows you to apply the program of fast rehabilitation – Fast-track.
The patient does not go through exhausting preparation for the operation with cleansing enemas, laxatives, does not starve. There is no need for hospitalization in a hospital on the eve of the operation. In 95% of cases, the patient is discharged from the hospital in the evening on the same day.
The key to the success of the program is early activation after surgery, early fluid intake, early feeding – after 2-3 hours, without drains and catheters. So, laparoscopy is a real embodiment of the principle “not scary – not painful – safe”.
Doctors providing operative gynecology services:
Andrey Dubinin
Elena Turlak
You can get detailed information and sign up for a consultation by phone: 8 (812) 676-30-60.
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