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Fertiloscopy as the foundation for improved management of infertility
Accurate diagnosis is a necessary step before the correct treatment can be identified.
There
is a category of infertile women with abnormalities or damage to the
upper part of their reproductive tract who at present remain
undiagnosed, at least until they receive IVF. These patients comprise
approximately 25-30% of total infertile women, and the specific causes
are, firstly endometriosis (growth of tissues like the lining of the
womb) in the cavity surrounding the ovaries and fallopian tubes, and
secondly "adhesions" (bands of connective tissue that may grow from
points damaged by genital infections) in this cavity.
These
abnormalities cannot be diagnosed externally, but only by surgical
examination. The current method of surgical examination is laparoscopy,
i.e. the same procedure that was used originally in IVF for harvesting
eggs. As outlined above, this is a major procedure, requiring deep
general anaesthetic, an overnight hospital stay, a visible scar on the
abdomen, and a low but finite risk of serious complications. For these
reasons it is unusual to carry out purely diagnostic laparoscopy, and
therefore this group of women remain undiagnosed, and are treated
inappropriately.
There is another abnormality, called Polycystic
Ovary Syndrome (PCOS) that can be diagnosed either by hormonal
diagnostic tests over several cycles, or by surgical inspection.
For
women with these problems, IUI is of no use until the problems are
corrected. In the case of endometriosis and of adhesions, surgery is
the only remedy (short of IVF), and in the case of PCOS, although it
can be treated by hormonal stimulation, it has been shown that a form
of surgery called ovarian drilling is the best treatment.
Because
it is very uncommon to carry out diagnostic laparoscopy (on account of
the cost and severity of the procedure, this means is that these women
remain undiagnosed, and receive many months of completely useless
treatment. They are then selected for IVF, which could have been
avoided if there had been an early diagnosis and appropriate surgery.
Fertiloscopy
is a modified form of laparoscopy, performed with a specialised
instrument inserted via the top end of the vagina, where there are very
few nerves, and there is easy access to the upper reproductive tract.
The operation is much less traumatic (local anaesthetic or light
general anaesthesia), less inconvenient (carried out on out-patients in
two hours), less dangerous and less costly than laparoscopy. In fact
the procedure is very well suited to being carried out in any ObGyn
clinic.
In addition, the instrument is designed so that, if
endometriosis, or adhesions are found, or if the subject has PCOS,
these can all be surgically treated as part of the original diagnostic
Fertiloscopy procedure, which can still be completed in less than 20
minutes in total.
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