Reducing the number of Endomentrial Cysts with laser and a hysteroscopy control can improve fertility by reducing the delay for pregnancy confirmation and improving embryo migration between day six and half and seventeen. Laser irradiation with a contact fiber, results in smaller subsequent endometrial scars. Performing this procedure in liquid environment, avoids smoke emission or foam production inside the uterus during the procedure.
Diode laser is mainly used in overseas to treat upper airways pathologies. It could also be used for other pathologies, such as some skin disorders or for facilitated ankylosis. Before cyst ablation by laser, perform breeding soundness examination, including endometrial biopsy.
To establish the prognosis and treat the underlying pathologies. It is impossible for placebo embryo transfer or exit. Demonstrating the procedure will be Pascal Lejeune and endoscopy specialized technician from our clinic.
During the preceding Estrus, perform a complete breeding soundness examination of the mare, including an endometrial biopsy to ensure that the mare can potentially get pregnant after the procedure. During the preceding Diestrous, count, measure and map endometriosis in the uterus using transrectal ultrasonography, guided by palpation with a 7.5 or 5 MHz linear rectal probe and calipers on the screen in a contention stock. Intramuscularly administer 250 micrograms of Cloprostenol to induce estrus within two to three days, at day six to seven, post ovulation.
Perform routine daily ultrasonography and cervix palpation to observe estrous signs. Including significant endometrial edema, antral follicle of 35 mm, or a softened and open cervix. Make sure that anyone entering the operating room is wearing eye protection.
After emptying of the mare's rectum, wrap the tail and clean the vulva aseptically using Iodine-Povidone. To ensure easy manipulation and comfort of the mare, intravenously administer 10 mg/kg Detomidine and 0.1 mg/kg Butorphanol in the juggler vein with a 21 gauge needle. Install the embryo collection catheter through the cervix and inflate the balloon with 40 ml of air.
Infuse the uterus 1.5 liters of sterile saline solution to inflate it, then deflate the balloon and remove the catheter. Pass the endoscope aseptically through the cervix within a sterile sleeve. Connect the 600 m quartz fiber to a diode laser operating at 980 nm.
And set the power at 20 to 25 Watts in continuous mode. Pass the flexible quartz fiber via the biopsy channel of a 10 mm diameter video endoscope. Until 3 to 4 cm of free fiber can be identified on the screen.
A minimum of 10 mm from the end of the fibers should be visible. Activate the laser to puncture the cyst. Ideally at its apex.
In some cases, multiple punctures at various locations are necessary to achieve complete voiding. The cystic fluid is then passively drained out into the uterus. After the cyst lining has collapsed around the fiber, deploy the laser until the membrane shrinks.
When acting in liquid medium, be sure that the fiber is in close contact with the cyst and verify the potential in the wound of cyst out punctured Perform transrectal ultrasonography of the uterus as many times as necessary during the procedure, to confirm that the endometrial cysts have disappeared. Collect the liquid infused in the uterus before the endoscopic procedure through a sterile cuffed catheter. Then flush the uterus with successive installations of one liter of sterile isotonic solution, until a clear liquid is collected.
After the procedure, administer general antibiotic treatment intramuscularly twice a day for three days. Administer 20 IU of oxytocin intravenously at the end of the procedure. On the next day, perform transrectal ultrasonography of the mare uterus.
Intraluminal free liquid is frequently observed. As long as free intraluminal fluid is observed by transrectal ultrasonography, and until the end of the heat, perform uterine lavage daily. Sometimes serum like limpid and yellow stained liquid is collected for several days.
Perform transrectal uterine ultrasonography, during the following diestrus to confirm disappearance of endometrial cysts and the absence of intraluminal free fluid. This protocol was used to treat cyst with diameters over 15 millimeters. Photoablation of the smaller cyst was also attempted, if they were present.
Generally large cysts were at the bifurcation or the bases of the horns. However, some of them were present in the body of the uterus and were also treated. Parietal cysts were more difficult to identify because of their location and their smaller size.
Only the smallest parietal cyst were impossible to treat, but they do not interfere with the embryonic vesicles movements and are not easily confused with day 14 embryos. Never forget the associated underlying causes of infertility. Perform uterine swaps on biopsies, then treat and prevent these fertility dealing pathologies with Verve surgeries or uterine allergies.
Multicentric studies about fertility observed before and after laser cyst ablation should be performed. However, semen quality, intimination timings and other external factors may induce extrinsic causes of variation.
