**7.9. Complications**

22 Enhancing Success of Assisted Reproduction



The diagnosis is based upon visualization of intrauterine adhesions either directly by hysteroscopy, or indirectly by imaging. The standard treatment of intrauterine adhesions is surgery with lysis under direct visualization. Intrauterine adhesions are cut hysteroscopically using current so that the uterine cavity appears normal. This is usually performed as an ambulatory procedure using operative hysteroscopy. Postoperative

Complete septum extending from fundus of uterus till cervix. Hysteroscopic resection uses hysteroscopy to operate within the uterine cavity. An intrauterine septum is cut using current, so that the uterine cavity becomes normal. Polyps, fibroids and uterine septums

A local or general anesthetic may be used. The uterus is filled with fluid and the hysteroscope is inserted through the cervix into the uterus. This device guides the physician to the fibroid, which is then removed in pieces with a wire loop. Sometimes a second procedure is needed to remove the entire fibroid. Pregnancy rates have been high among women who had this procedure to remove a fibroid that was causing fertility problems.

Congenital uterine malformations are a group of miscellaneous anomalies in the uterine cavity that may alter the reproductive outcome of the patient. Each type of uterine anomaly has a different impact on pregnancy outcome. These are usually asymptomatic, but are sometimes associated with recurrent pregnancy loss or infertility. A uterine septum is a fibrous band that divides an otherwise normal womb into two halves. It is a much commoner condition than bicornuate uterus and can be associated with subfertility or recurrent miscarriage Obstetrical prognosis of patients presenting repeated pregnancy loss and septate uterus is statistically improved by hysteroscopic metroplasty. Hysteroscopic metroplasty is a day-case procedure and pregnancy can be attempted soon afterwards.

There have been a number of studies published that indicates office-based hysteroscopy identifies uterine defects in a large number of infertility patients. Office hysteroscopy is a very simple procedure that requires minimal instrumentation. Office hysteroscopy is

management is focused upon reducing the risk of reformation of adhesions.



**7.5. Septum resection** 

may be treated with this technique.

**7.7. Hysteroscopic metroplasty** 

**7.8. Office hysteroscopy** 

**7.6. Hysteroscopic resection of fibroid** 

Complications occur rarely during hysteroscopy A possible problem is uterine perforation when either the hysteroscope itself or one of its operative instruments breaches the wall of the uterus. Injury of the bowel during a perforation, the resulting peritonitis can be fatal. Cervical laceration, intrauterine infection, electrical and laser injuries, and complications caused by the distention media can be frequently encountered. The use of insufflations media can lead to serious and even fatal complications due to embolism or fluid overload with electrolyte imbalances. Other possible complications include allergic reactions and bleeding. The overall complication rate for diagnostic and operative hysteroscopy is 2% with serious complications occurring in less than 1% of cases. The complications of hysteroscopy:

