November 29, 2009
Fertility is dependent upon healthy gametes capable of fertilizing and implanting in a uterus with a normal endometrial lining unimpeded by any uterine or endometrial pathology. The sperm need to be in sufficient number and capable of swimming up through a cervix which is not inflamed and provides a mucous medium that promotes sperm motility. The eggs need to ovulate and be picked up by normal healthy fimbriated ends (finger like projections) of the fallopian tubes. The tubes need to be patent with normal micro hairs called cilia that assist in the transport of the egg one third of the way down the tube where one of the sperm will fertilize it.
The conceptus needs to undergo cell division, growth and development as it traverses the tube and makes its way to the uterine cavity by the embryo’s fifth day of life at which point it is a blastocyst. The blastocyst hatches out of its shell (zona pellucidum) and implants into the endometrial lining requiring adequate blood flow. Occasionally, an intramural myoma (fibroid in the uterine muscle wall) may obstruct adequate blood flow to the endometrial lining. However, it is the submucosal myoma, inside the uterine cavity, that produces an IUD like effect of irritating the uterine lining that can prevent implantation. An endometrial polyp (endometrial tissue protruding into the uterine cavity may have a similar effect.
A hydrosonogram is a procedure where your doctor or a radiologist injects water through your cervix into your uterus while performing a transvaginal ultrasound of the uterus. The water shows up as black on ultrasound against a white endometrial border. This way a defect in the smooth edges of the uterine cavity caused by an endometrial polyp or fibroid may be easily seen.
The hydrosonogram is performed by placing a thin tubular plastic catheter through the cervix into the uterine cavity. Water is injected using a syringe connected to this plastic tube. There may be mild cramping which is occasionally worse when a patient has fallopian tube disease or obstruction. This can be combined with a trial of transfer using an embryo transfer catheter prior to performing an IVF cycle.
Both polyps and fibroids in the uterine cavity can cause abnormal vaginal bleeding and occasionally cramping. They are almost always benign. An endometrial polyp may be removed by a hysteroscopy, dilatation and curettage procedure. A hysteroscopy is performed vaginally where a scope is placed through the cervix into the uterus in order to look inside the uterine cavity. This can often be performed as an outpatient in an ambulatory or office based surgery unit. The risk of bleeding, infection or injury to the uterus is extremely rare from this surgery which takes place while a patient is asleep under anesthesia.
Resection of a submucosal myoma is a more difficult and longer procedure than the polypectomy. It too is performed hysteroscopically without cutting. Sometimes, especially when the fibroid is large, it will take multiple procedures in order to remove the fibroid in its entirety. It will be necessary to repeat the hydrosonogram after the fibroid resection to make sure the cavity is satisfactory for implantation. Failure to do these procedures to remove endometrial polyps and submucosal myomata will not only prevent pregnancy from occurring spontaneously, it will prevent implantation even with in vitro fertilization.
The conceptus needs to undergo cell division, growth and development as it traverses the tube and makes its way to the uterine cavity by the embryo’s fifth day of life at which point it is a blastocyst. The blastocyst hatches out of its shell (zona pellucidum) and implants into the endometrial lining requiring adequate blood flow. Occasionally, an intramural myoma (fibroid in the uterine muscle wall) may obstruct adequate blood flow to the endometrial lining. However, it is the submucosal myoma, inside the uterine cavity, that produces an IUD like effect of irritating the uterine lining that can prevent implantation. An endometrial polyp (endometrial tissue protruding into the uterine cavity may have a similar effect.
A hydrosonogram is a procedure where your doctor or a radiologist injects water through your cervix into your uterus while performing a transvaginal ultrasound of the uterus. The water shows up as black on ultrasound against a white endometrial border. This way a defect in the smooth edges of the uterine cavity caused by an endometrial polyp or fibroid may be easily seen.
The hydrosonogram is performed by placing a thin tubular plastic catheter through the cervix into the uterine cavity. Water is injected using a syringe connected to this plastic tube. There may be mild cramping which is occasionally worse when a patient has fallopian tube disease or obstruction. This can be combined with a trial of transfer using an embryo transfer catheter prior to performing an IVF cycle.
Both polyps and fibroids in the uterine cavity can cause abnormal vaginal bleeding and occasionally cramping. They are almost always benign. An endometrial polyp may be removed by a hysteroscopy, dilatation and curettage procedure. A hysteroscopy is performed vaginally where a scope is placed through the cervix into the uterus in order to look inside the uterine cavity. This can often be performed as an outpatient in an ambulatory or office based surgery unit. The risk of bleeding, infection or injury to the uterus is extremely rare from this surgery which takes place while a patient is asleep under anesthesia.
Resection of a submucosal myoma is a more difficult and longer procedure than the polypectomy. It too is performed hysteroscopically without cutting. Sometimes, especially when the fibroid is large, it will take multiple procedures in order to remove the fibroid in its entirety. It will be necessary to repeat the hydrosonogram after the fibroid resection to make sure the cavity is satisfactory for implantation. Failure to do these procedures to remove endometrial polyps and submucosal myomata will not only prevent pregnancy from occurring spontaneously, it will prevent implantation even with in vitro fertilization.
Share this on
December 04, 2009