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DR. HEBER DUNAWAY: Another surgical procedure that we turn to is called hysteroscopy. Hysteroscopy is a technique where we can look into the uterus directly and it is primarily utilized for several instances, such as intrauterine adhesions. Sometimes patients have had D&Cs, dilatation and curettage procedures for either miscarriages or dysfunctional uterine bleeding. It's rare but sometimes it can cause adhesions. So we can go in and actually lyse [phonetic] or breakthrough and break these adhesions.

One of my interests is uterine anomalies. While sometimes patients come in who've had multiple miscarriages, we have what is called a septate uterus, a developmental abnormality where the midline portion of the uterus is covered by this septum or growth. This growth has very poor vascularization and as a result, if a pregnancy attaches to it, it doesn't grow.

The average miscarriage rate in the United States is probably around 15% of all known pregnancies. With septums it could be as high as 90%. So by doing an operative hysteroscopy you can actually greatly reduce the miscarriage rate down to almost 15%.

Sometimes we encounter fibroids, which I mentioned earlier, as an open procedure. Sometimes these tumors actually grow into the uterine cavity. These are sometimes associated with heavy bleeding and menstrual discomfort and the benefit of the hysteroscope in this manner is that in many cases if you have to open the uterus to remove these tumors, the patient has to be committed to a C-section at that point forward. If you're able to resect these tumors, and only those tumors that are in the cavity, mind you, those can be removed and the patient can have a normal delivery unless some obstetrical situation arises that a C-section is necessary.