Hysteroscopy is what I am. I am not only carried out through the natural cavity – vagina, but also has high recognition of lesions in the endometrium, less traumatic, quick postoperative recovery, and can be carried out in outpatient clinics, so I have gained a lot of popularity at all levels of hospitals, especially in the reproductive specialty clinics nowadays when the problem of infertility is becoming more and more serious. I have been widely used in the reproductive specialty clinic, especially in the growing problem of infertility. I can diagnose or treat the problems of uterine adhesion, menorrhagia, thin endometrium, thick endometrium, endometrial polyp, submucosal fibroid, uterine diaphragm, saddle uterus, unicornuate uterus, bicornuate uterus, endometrial tuberculosis, embedded uterine IUD, failure of IVF, recurrent abortion…..and so on! I can diagnose or treat many, many problems. However, I am not omnipotent, nor am I that scary. There may still be some misunderstandings about me, and I am here today to talk about them, and I don’t want to be misunderstood! Misunderstanding one, I can only be clean menstruation 3 to 7 days Outpatient many patients often ask the clinician back, more than 7 days after the clean menstruation can still do hysteroscopy surgery? China’s authority, the Chinese Medical Association Obstetrics and Gynecology Section of the Gynecological Endoscopy Group of the hysteroscopic operation norms provide for the choice of the timing of the operation only 2: (1) surgery should be selected in the early follicular period, when the endothelium is thin, the field of vision is relatively open, easy to operate; (2) preoperative medication has been carried out before the pre-treatment can be carried out after completion of pretreatment surgery. For the first one is the clinical usually stipulated 3-7 days after menstrual cleansing, which is more applicable to the surgery that requires relatively open surgical field, such as the treatment of uterine adhesion, submucous fibroid, and uterine longitudinal septum. In fact, avoiding the menstrual period is the timing of hysteroscopy or surgery, and the doctor will decide the timing of the procedure based on the patient’s specific situation. For infertile women, I often perform it 3-7 days after the clean menstruation, but for women with recurrent miscarriages or repeated implantation failures, I prefer to perform it in the mid-luteal phase, when the development of the endometrium can be staged and some endometrial estrogen and progesterone and other receptor tests can be performed to better determine the cause and guide the treatment. Myth 2, I will damage the endometrium, resulting in thinning of the endometrium, lack of endometrial growth, and decreased menstrual flow I actually grow eyes that look at the endometrium to perform the operation, and I basically operate on the functional layer of the endometrium when operating in the uterine cavity in non-pregnancy. I have far less impact on the lining than procedures such as abortions, purges, and blind scrapings. Sometimes I will perform a combined curettage procedure, where the doctor has a clear view of the lining of the uterus and will try to scratch it as lightly as possible; in fact, a large number of studies have shown that this is more conducive to embryo implantation. Sometimes I need a combined excision procedure, and my doctor will also try to minimize damage to the lining, such as linear dissection or cold knife snipping; if I need to use a procedure such as electrocision, I can also use anti-adhesion treatments such as uterine water bladder, IUD, estrogen, etc., through prophylactic use after the procedure. Generally, I do not damage the basal layer of the endometrium and do not result in thinning of the endometrium, failure of the endometrium to grow, or a decrease in menstrual flow. Women treated by me may indeed experience menstrual disorders for a short period of time for a variety of reasons, but they usually return to normal after 1~2 cycles. Myth 3: After my treatment, women need to rest for 3-6 months before pregnancy The repair function of the endothelium is very powerful. Whether the endothelium recovers or not depends on whether the regenerable basal layer of the endothelium is intact and whether there is normal ovulation. Generally speaking, as long as normal menstruation is resumed after the miscarriage, and the amount of menstruation is the same as before, it basically indicates that the endothelium has recovered. Some studies have found that endometrial pathology on as early as the 9th day after miscarriage reveals that the endometrium has returned to normal; even in a one-month review after hysteroscopic surgery for submucosal leiomyoma, the endometrium has completely covered the huge incision wound. There are also studies suggesting that the speed of recovery after surgery for uterine abnormalities is: endometrial polyps > uterine adhesions > uterine septum > submucosal fibroids. It has also been shown that preparing for pregnancy as soon as possible after an abortion clearance procedure has a higher success rate than preparing for pregnancy after 3-6 months of rest. Therefore, most of the post hysteroscopy pregnancy preparation patients, menstruation recovery should be as soon as possible to prepare for pregnancy. Myth 4: After hysteroscopy-related surgeries such as uterine adhesion isolation, uterine mediastinum electrosurgery, and uterine submucosal fibroid removal, will there still be uterine adhesions? A second hysteroscopy is needed Although the repair function of the endometrium is powerful, there are still some cases where the problem cannot be solved at once. The re-adhesion rate after hysteroscopic separation of uterine adhesions is as high as 62.5%. Re-adhesion occurs in 50% of patients after surgical treatment of severe uterine adhesions and 21.6% of those with moderate uterine adhesions. In addition, the uterine cavity is also susceptible to adhesions due to the large amount of endometrial damage caused by longitudinal septoplasty and submucosal fibroid removal. It has been shown that one month after these surgeries, uterine adhesions were 8% after submucosal myomectomy, 14% after mediastinectomy, and 56% after separation of uterine adhesions. Therefore, secondary hysteroscopy is still recommended for these individuals at high risk of uterine adhesions, usually at 1-2 months postoperatively. It is important to note that in severe cases of uterine adhesions, multiple surgeries may be required to gradually restore the uterine cavity to its original shape, with most patients getting better as they separate, and a small percentage getting worse as they separate, which is related to the amount of endometrial lining that remains. Myth five, ultrasound diagnosis, hysteroscopic diagnosis and pathologic diagnosis is inconsistent, which link misdiagnosis Any kind of examination and diagnostic methods have their own advantages and disadvantages, the accuracy is different. Clinically we can find a lot of inconsistencies, but also the best evidence. For example, ultrasound did not find abnormalities, often seen under the hysteroscope lesions, such as inflammation, polyps, masses; hysteroscopy did not find abnormalities, and pathology suggests inflammatory cell infiltration, polyps, tuberculosis, etc.; may also be seen under the hysteroscope suspected abnormality, but the pathology did not suggest abnormality, which may also be related to the endometrial sampling. For endometrial lesions, the recognized gold standard for diagnosis is hysteroscopy + pathology. Women with abnormal uterine bleeding, abnormalities in the uterine cavity detected by ultrasound, failed “test tubes”, unexplained infertility, or recurrent miscarriages should undergo hysteroscopy in order to more accurately find the cause of the infertility and improve the chances of pregnancy.