Surgery to the uterine cavity
Hysteroscopic surgery involves the insertion of a small camera through the vagina and the cervix without the need for an incision in the abdomen. This can be performed to treat a range of intrauterine problems. These include:
- Removal of polyps (polypectomy)
- Division of uterine septum
- Correction of intrauterine adhesions (Asherman’s Syndrome)
A septum is a bridge of fibrotic tissue which extends down the middle of the uterine cavity. In some cases the septum will be very small and may have minimal, if any, effect on fertility. In other patients the septum can be large which, as well as adversely affecting fertility, can also increase the likelihood of miscarriage and surgery to correct this may be recommended.
Adhesions can be caused by any trauma that occurs within it. Most adhesions can be attributed to miscarriage although any pregnancy, including a normal delivery at term, can cause intrauterine scarring. It is therefore an area that should be examined if the patient has become infertile after a preceding pregnancy.
The cavity is generally checked with an X-ray called a hysterosalpingogram which may show any significant uterine scarring. A hysteroscopy may then be performed to confirm this, and at the same time the adhesions are divided using a tiny pair of scissors. Occasionally contraceptive coils are placed in the cavity to prevent re-formation of this scarring. These are removed 4–6 weeks later. Occasionally a further procedure may be required.