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Hysteroscopy and laparoscopy are 2 useful tools doctors use to evaluate and treat various structural causes of infertility. In some cases, correction of these abnormalities can result in a successful pregnancy.

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Hysteroscopy

Hysteroscopy is a procedure where a device, called a hysteroscope (a thin telescope with a light and camera at the end), is inserted into your body through the vagina to allow your doctor to have an up-close look at your cervix and uterus. It is a non-surgical procedure that doctors use to:

  • Investigate symptoms or problems, such as heavy periods, repeated miscarriages or difficulty getting pregnant;

  • Diagnose conditions, such as malformation of the uterus, fibroids, polyps (non-cancerous growths in the uterus) or uterine adhesions (scar tissue that can affect fertility); and

  • Treat conditions and problems, such as displaced intrauterine devices (IUD), or e.g. if a polyp is found during the procedure, your doctor will remove it during the hysteroscopy.

 

A hysteroscopy is usually carried out as an outpatient. Some women experience cramping or discomfort during and after the procedure but most can resume normal activities straight after.

Real women say

I did a hysteroscopy to remove my polyps before I could do my frozen embryo transfer. However, I also know of friends who managed to conceive with polyps.

 

Laparoscopy (a. k. a. keyhole surgery)

Laparoscopy, also known as keyhole surgery, is a type of surgery where a camera, called the laparoscope, is used to look inside the abdomen. Small incisions are made on the body (near the belly button) and the abdomen is filled with carbon dioxide to lift the abdomen away from the internal organs, giving the surgeon a better view. Other small incisions may be made to allow additional surgical instruments to be used during the surgery.

 

Laparoscopy is a surgery that doctors use to:

  • Diagnose and treat endometriosis, pelvic pain and pelvic inflammatory disease;

  • Remove or biopsy growths such as tumours, polyps, fibroids, cysts or ectopic pregnancies;

  • Repair or remove a blocked fallopian tube; and

  • Correct abnormalities such as uterine adhesions

 

While a laparoscopy is less painful and allows for faster recovery times than normal surgeries, it is still an invasive procedure.

 

Real women say…

“Before you agree to a laparoscopy operation understand fully the effects of what you have and how that impacts your chances of getting pregnant. Also, ask your doctor about the side effects and recovery time.”

“Hysteroscopy is less invasive. It can be just checking inside without doing anything or can be surgery like remove polyp or endo scratching. Procedure through the vagina. I removed a small fibroid by hysteroscopy. Laparoscopy is the incision of two or three holes depending. It is a surgery to remove fibroid or to clear endometriosis. Hysteroscopy for me is day surgery and I am back to normal the same day. Laparoscopy I took one week to recover as the wound needs time to heal. Success rate depends not just on the procedure but egg quality. I did a laparoscopy but failed my cycle. I did a hysteroscopy and got a bfp. Many friends did laparoscopy to clean up their womb and managed to bfp naturally. So it really depends.”

“My surgery took a total of 6 hours and I was in hospital for 4 whole days. The recovery time was around 3 months. However, before we went ahead with the surgery, we did all our IVF cycles so that we had a bank of embryos to transfer post-recovery of surgery. In the three months, rest and take it easy. Then decide when you are ready to prepare your body for the FET as you have to feel both physically and mentally ready.”

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Endometrial Scratch

Endometrial scratching is a controversial technique that is believed to help an embryo implant in the uterus after in-vitro fertilization. It involves wounding (or “scratching”) the lining of the womb slightly.

Scientific studies suggest some benefit from endometrial scratching. Scratching appears to help women who have experienced repeated implantation failure, but not so for couples who have fertility challenges. There is, however, no clear evidence that endometrial scratching can increase the probability of a successful pregnancy. As a result, most fertility specialists do not actively recommend it. The procedure is also uncomfortable and can be painful.

Your doctor may still suggest an endometrial scratch if you have experienced recurrent unsuccessful IVF cycles with good quality embryos.

Fertility Drugs

Depending on your doctor’s assessment of your fertility, he or she may recommend fertility drugs as a first treatment option before exploring more invasive procedures like IUI or IVF. The two common drugs are Clomiphene Citrate (commonly known as Clomid) or Letrozole.

Clomiphene Citrate (a.k.a. Clomid)

Clomid is the most common oral fertility drug used to treat certain types of female infertility. It works by making the female brain think that your estrogen levels are lower than they actually are. This causes the pituitary gland to increase the secretion of follicle stimulation hormones (FSH, the hormone responsible for stimulating your ovaries to develop eggs) and luteinizing hormones (LH, the hormone responsible for stimulating ovulation).

Clomid is usually prescribed to women who suffer from Polycystic Ovarian Syndrome (PCOS). While not everyone will respond to this medication, such as women with primary ovarian insufficiency or suffering from early menopause, Clomid usually results in ovulation in about 80% of women who take it.

Dosage and Duration

Clomid comes in 50mgl tablets. It is taken orally by women for 5 days in a row, early in the menstrual cycle. The dosage will vary, depending on how you respond to the drug. Your doctor would usually start with a lower dosage to see how your body responds to the drug. Some doctors may ask for your blood to be regularly taken to measure the hormone levels in your body, or to have a transvaginal ultrasound to check on your ovarian follicles. This information will help them determine when you should begin having intercourse or when to get your IUI, or even to determine the appropriate dose for your next cycle.

Side Effects

Clomid is generally a safe medication, however, there are side effects. These include:-

  • Headaches

  • Bloating

  • Nausea

  • Hot Flashes

  • Mood Changes

  • Breast Tenderness

  • Blurring or Double Vision

Taking Clomid may also result in a higher risk of multiple pregnancies, as multiple follicles may be released by your body during ovulation. The chances of this happening is around 7% for twins and 0.5% for triplets.

Clomid can cause your uterine lining to be thinner and reduce the amount and quality of your cervical mucus. This can potentially interfere with the ability of sperm to travel in the uterus and fallopian tubes. Most doctors also don’t recommend Clomid for more than 3 to 6 cycles, due to a decreased pregnancy rate that seems to occur with continuous usage.

Practical pointers

It is recommended to

 

  • Take the pill at the same time each day to ensure the best optimal results.

  • Take the pill at night before you sleep, so as to sleep through the side effects as much as possible.

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Letrozole (a.k.a. Femara)

Letrozole, also known as Femara, was originally developed as an oral treatment for breast cancer in postmenopausal women. Today, it is prescribed as a second line choice after Clomid when doctors realised it helped treat infertility among younger women. Femara is becoming more popular with doctors as it seems to have less side effects and less chances of multiple pregnancies as compared to Clomid.

Femara induces ovulation by indirectly stimulating the ovary to produce more follicles. It does this by blocking aromatase, an enzyme needed in the formation of estrogen. By lowering estrogen, Femara indirectly helps to stimulate the egg follicles, resulting in the release of an egg for ovulation.

Dosage and Duration

Femara comes in 2.5mg tablets. Similar to Clomid, it is taken orally by women for 5 days in a row, early in the menstrual cycle. Your doctor will decide on the dosage.

Side Effects

Like Clomid, Femara is generally a safe medication, however, there are side effects. These include:-

  • Dizziness

  • Bloating

  • Headaches

  • Hot Flashes

  • Fatigue

  • Difficulty Sleeping

  • Breast Pain

  • Blurred Vision

  • Upset Stomach

  • Spotting or Unusual Menstrual Bleeding

While rare, some women taking Femara may develop a condition known as ovarian hyperstimulation syndrome (OHSS) which may manifest with symptoms ranging from bloating, diarrhea to extreme shortness of breath and chest pains.

Practical pointers

It is recommended to 

  • Take the pill at the same time each day to ensure the best optimal results.

  • Take the pill at night before you sleep, so as to sleep through the side effects as much as possible.

 

 Real women say…

“I took Clomid for 3 months, but it didn’t seem to help with my ovulation. However, in the first month of taking Letrozole, I ovulated straight away.”