I have been working at the Infertility Center in Tehran for the last 15 years and I have done numerous advanced hysteroscopy operations. Since hysteroscopy was introduced into my country 25 years ago, few doctors have been willing to perform hysteroscopy and there are even fewer experts in advanced hysteroscopy.
Unfortunately, the majority of the gynecologists prefer D+C for common problems like polyps and retained product of conception, which is a blind procedure with lots of complications. On occasion these aggressive curettages for RPOC end up in totally destroyed endometrium.
During the last 15 years in IVF center, I have encountered many patients with infertility, some of them in IVF cycles with a thin endometrium. Such patients are victims of aggressive curettage after miscarriage in which the basal layer of the endometrium has been destroyed and the endometrium will not respond to any dosage of estrogen. Why have they not undergone hysteroscopy?
The reason is most gynecologists prefer to stick to their old routines. I have thought a lot about this problem. I believe the less sophisticated the hysteroscopy device is and the fewer the complications, the more the gynecologist will show interest in this procedure, especially in common cases like polyps and RPOC.