Combining advanced diagnostic techniques with novel treatment methods is crucial for addressing infertility. In the context of an abnormal uterine microbiome and possible Chronic Endometritis (CE), Diagnostic Hysteroscopy allows for direct visualization and assessment of the uterine cavity, helping to identify inflammation, infections, or structural abnormalities that may contribute to infertility. This is particularly important in cases of CE, a persistent condition that complicates management and leads to infertility.
Comprehensive Infertility Treatment Strategy
Incorporating diagnostic hysteroscopy and intrauterine antibiotic infusions into the treatment protocol offers a comprehensive approach to managing infertility. This strategy addresses both the microbial imbalances and the chronic inflammation of the endometrium, significantly improving the chances of successful conception and pregnancy outcomes.
WE GOT YOU.
In our experience and in accordance with recent research, combining Intrauterine Antibiotic Infusions (IAI) (uterine antibiotic washes) with oral antibiotic administration (OAA), has shown significant improvements in treatment success rates compared to OAA alone in cases of persistent infection. In a study involving 80 CE patients with recurrent implantation failure or recurrent pregnancy loss, the combined IAI and OAA therapy not only enhanced treatment effectiveness but also increased clinical pregnancy rates without additional side effects.
Comprehensive Infertility Treatment Strategy
Incorporating diagnostic hysteroscopy and intrauterine antibiotic infusions into the treatment protocol offers a comprehensive approach to managing infertility. This strategy addresses both the microbial imbalances and the chronic inflammation of the endometrium, significantly improving the chances of successful conception and pregnancy outcomes.
Procedure Overview
A diagnostic office hysteroscopy is performed by our very experienced gynecologists (Dr. Vassilis Kapetanios MD, PhD, OB/GYN), a published author on the subject of Intrauterine Antibiotic Infusions (IAI) and Chronic Endometritis (CE), without the need for anesthesia other than oral painkillers or topical anesthetic. The procedure takes less than 10 minutes, and each patient may feel a different level of discomfort ranging from slight discomfort to a little painful but nevertheless tolerable. A diagnostic office hysteroscopy, as opposed to a hysteroscopy in a hospital environment under anesthesia, is advantageous because it is little more than an extended office visit providing a direct diagnosis of any inflammation or problems of the endometrium. It is a safe procedure, without any significant complications, and you can resume normal activities immediately after.
Optimal Timing and Process
The best time to have a hysteroscopy is between your 7th and 9th day of your cycle, and you need to be sure that you are not pregnant (through testing prior to the procedure if needed). During the office hysteroscopy, Dr. Kapetanios will examine the cervix, the uterus, and the entrance of the tubes and will determine if there are any anatomical issues or a macroscopic appearance of inflammation indicative of endometritis. Following the procedure, you will be given a DVD with the video of the procedure to be able to evaluate the progress of the treatment in the future and to show it to another specialist if you would like a second opinion.
Follow-up and Treatment Plan
Depending on the results of the hysteroscopy (e.g., presence of endometritis), we may decide to proceed with the first endometrial antibiotic wash (IAI). Follow-up washes on the following days may take place with a much smaller catheter so there isn't any discomfort involved during a wash. Each procedure is no longer than 5 to 10 minutes, and usually, around 3 to 5 washes (maximum 10) will be enough to complete the treatment.
Additional Diagnostic Options
During an office hysteroscopy, a biopsy for histological examination is possible if the doctor thinks further investigation is required. In the unlikely event that following an office hysteroscopy, we decide that a hospital hysteroscopy (with D&C) is needed, that could take place in one of the best private maternity/gynecological hospitals in Athens. The procedure will be performed by the same Dr. (Dr. Vassilis Kapetanios MD, PhD, OB/GYN).
HOW IT WORKS.
We are here to support you and walk you through your next steps.
A perfect protocol will be created, especially designed to suit your planning & needs.
By leveraging our expertise in uneplained infertility, we provide you with the best possible chances of success.
Is your infertility really ‘’unexplained’’ or are you still undiagnosed?If you have been struggling with infertility and haven’t been getting convincing answers, chances are you are still missing a piece of the puzzle.
STILL HAVE QUESTIONS?
These our the most common questions regarding this procedure.
If you have more, please refer to our Q&A page.
Office hysteroscopy uses a thin endoscope, only 2.9 mm in diameter, which passes through cervix with ease because cervical canal is 3 mm wide in most women. The procedure takes only 3-4 mins to complete, that is to obtain a detailed view of endocervix, uterine cavity, tubal openings, endometrial surface and detect any possible pathology (e.g. polyps, inflammation, adhesions, myomas protruding inside endometrial cavity).
We recommend taking one tab of Butylscopolamine 10 mg and one tab Indomethacin 75 mg, one hour prior to procedure (it is better to have a light meal before taking medication). In case you are allergic to NSAIDs (like Indomethacin) you can have Butylscopolamine plus 500 mg of Paracetamol./p>
The presence and severity of chronic inflammation of the endometrium (endometritis) is established with specific hysteroscopic criteria: focal of diffuse hyperemia, presence of micro-polyps (<1 mm in size), focal hyperplasia, stromal edema. A positive microbiome test acts as a conjugative tool for tailoring the anti-microbial therapy (antibiotic, anti-virus or anti-fungal) for the specific patient. A follow up hysteroscopy with signs of remaining endometritis although a normalized microbiome, necessitates a new course of treatment. On the other hand, office hysteroscopy can reveal possible endometrial pathology, other than microbial infection, like polyps, adhesions, hyperplasia or sub-mucous fibroids that require correction with operative hysteroscopy at the clinic, with anesthesia.
