What Is Hysteroscopy?

Hysteroscopy is a minimally invasive medical procedure that allows a doctor to examine the inside of the uterus. It is performed using a thin instrument called a hysteroscope, which has a light and camera to provide a clear view of the uterine cavity.

Hysteroscopy may be recommended to investigate abnormal uterine bleeding, identify abnormalities inside the uterus, or treat certain conditions that may affect reproductive health. In fertility care, it can help doctors evaluate the uterine cavity when a problem is suspected.

At Jyoti IVF, a fertility specialist can assess your symptoms, medical history, and diagnostic reports to determine whether hysteroscopy may be appropriate for your fertility evaluation or treatment.

Unlike procedures that require large abdominal incisions, hysteroscopy is performed by passing the instrument through the vagina and cervix into the uterus. Depending on the purpose of the procedure, it may be used for diagnosis, treatment, or both.

What Are the Types of Hysteroscopy?

Hysteroscopy is generally classified into two main types: diagnostic hysteroscopy and operative hysteroscopy.

1. Diagnostic Hysteroscopy

Diagnostic hysteroscopy is performed to examine the uterine cavity and investigate possible abnormalities.

It may be recommended when a patient experiences abnormal uterine bleeding, has suspicious findings on an ultrasound scan, or requires further evaluation of the uterus as part of a fertility assessment.

Conditions that may be identified include:

• Uterine polyps.
• Certain submucosal uterine fibroids.
• Intrauterine adhesions or scar tissue.
• Uterine septum and other structural abnormalities.
• Certain abnormalities of the uterine lining.

If an abnormality is identified, the doctor may recommend additional investigations or treatment. A biopsy may also be performed when clinically indicated.

2. Operative Hysteroscopy

Operative hysteroscopy is used to treat certain abnormalities inside the uterus. Specialised instruments can be passed through the hysteroscope to perform procedures without requiring a large surgical incision.

Depending on the findings, operative hysteroscopy may be used for:

• Polypectomy: Removal of uterine polyps.
• Hysteroscopic myomectomy: Removal of selected fibroids that project into the uterine cavity.
• Adhesiolysis: Division of scar tissue or adhesions inside the uterus.
• Uterine septum resection: Correction of a uterine septum in selected cases.
• Endometrial assessment or biopsy: Collection of tissue when further examination is needed.

The procedure selected depends on the type, location, and severity of the abnormality, as well as the patient’s medical history and treatment goals.

Why Is Hysteroscopy Performed?

Hysteroscopy can help doctors investigate and manage several conditions affecting the uterine cavity.

Common reasons for recommending hysteroscopy include the following.

1. Investigating Uterine Abnormalities

Ultrasound scans may reveal possible polyps, fibroids, adhesions, or other abnormalities inside the uterus. Hysteroscopy allows the doctor to examine the uterine cavity directly and determine whether further treatment is needed.

2. Evaluating Abnormal Uterine Bleeding

Hysteroscopy may be recommended for patients experiencing unusually heavy, prolonged, irregular, or otherwise unexplained uterine bleeding. It can help identify structural causes, although additional tests may be required depending on the patient’s symptoms.

3. Assessing Fertility Concerns

The shape and condition of the uterine cavity can be relevant to reproductive health. When an abnormality is suspected, hysteroscopy may help determine whether it could be contributing to difficulty conceiving or pregnancy loss.

However, hysteroscopy is not routinely necessary for every person experiencing infertility. The doctor decides whether it is appropriate based on the findings from the initial fertility evaluation.

4. Treating Uterine Polyps and Certain Fibroids

Some polyps and fibroids can affect the uterine cavity and may contribute to abnormal bleeding or reproductive difficulties. Operative hysteroscopy can be used to remove suitable abnormalities when treatment is indicated.

5. Investigating Intrauterine Adhesions

Adhesions are bands of scar tissue that can develop inside the uterus, sometimes following previous uterine procedures or other conditions. Hysteroscopy allows the doctor to assess these adhesions and, when appropriate, treat them.

6. Examining the Uterine Lining

When a closer examination of the uterine lining is needed, hysteroscopy may be used alongside other investigations. Tissue samples can be collected in selected cases for laboratory examination.

How to Prepare for a Hysteroscopy

Preparation depends on whether the procedure is diagnostic or operative, the type of anaesthesia used, and your medical circumstances.

Your healthcare provider will explain the necessary steps before your appointment.

General preparation may include:

1. Discuss your medical history: Inform your doctor about existing medical conditions, previous surgeries, allergies, and any possibility of pregnancy.
2. Review your medications: Tell your doctor about prescription medicines, over-the-counter drugs, and supplements you take.
3. Follow fasting instructions: Fasting may be required if sedation or general anaesthesia is planned. Follow the specific instructions provided by your medical team.
4. Ask about the timing: The procedure may be scheduled at a particular stage of your menstrual cycle, depending on the reason for the examination.
5. Arrange transport if needed: If sedation or general anaesthesia is used, arrange for someone to take you home.
6. Follow personal preparation instructions: Your doctor may provide additional advice based on the planned procedure.

Hysteroscopy is generally avoided during an ongoing pregnancy and may be postponed if an active pelvic infection is present.

What Happens During a Hysteroscopy?

The exact procedure depends on whether the doctor is examining the uterus or treating an identified abnormality.

Step 1: Preparation

You may be asked to change into a hospital gown and empty your bladder. The healthcare team will explain the procedure and confirm the planned approach.

Step 2: Anaesthesia or Pain Relief

Diagnostic hysteroscopy may be performed without general anaesthesia, using appropriate pain relief or local anaesthesia when needed. Operative procedures may require sedation, regional anaesthesia, or general anaesthesia, depending on their complexity and the clinical setting.

Step 3: Inserting the Hysteroscope

The doctor gently passes the hysteroscope through the vagina and cervix into the uterus. The instrument allows the doctor to view the uterine cavity without making an abdominal incision.

Cervical dilation may be required in some cases, depending on the instrument and procedure.

Step 4: Examining the Uterine Cavity

A sterile fluid is usually introduced to gently expand the uterine cavity, allowing the doctor to see the lining more clearly on a monitor.

The doctor examines the uterine cavity for abnormalities, including polyps, fibroids, adhesions, or other structural findings.

Step 5: Treating Abnormalities When Required

If operative hysteroscopy has been planned and treatment is appropriate, specialised instruments may be used to remove or correct certain abnormalities during the same procedure.

Step 6: Completing the Procedure

Once the examination or treatment is complete, the hysteroscope is removed. The duration varies according to the complexity of the procedure.

A diagnostic hysteroscopy may take approximately 5–15 minutes, while operative hysteroscopy can take longer, sometimes considerably longer depending on the treatment required.

What Happens After a Hysteroscopy?

Recovery depends on the type of hysteroscopy performed and whether anaesthesia was used.

Many patients go home on the same day after a short period of observation. A longer stay may be required in certain circumstances.

After the procedure, you may experience:

• Mild menstrual-like cramps.
• Light vaginal bleeding or spotting.
• Temporary discomfort or bloating.

These symptoms generally improve over the following days, although recovery varies between patients.

Your doctor may recommend the following precautions:

• Follow medication instructions: Take pain relief or other prescribed medicines as directed.
• Resume activities gradually: Return to your usual routine when you feel comfortable and follow any restrictions given by your doctor.
• Follow advice about sexual activity: You may be advised to avoid intercourse, tampons, or inserting anything into the vagina for a period after the procedure.
• Attend follow-up appointments: Your doctor will discuss the findings and explain whether further investigations or treatment are needed.

Seek prompt medical attention if you experience severe or worsening abdominal pain, heavy vaginal bleeding, fever, foul-smelling vaginal discharge, or other concerning symptoms.

What Are the Benefits of Hysteroscopy?

Hysteroscopy offers several potential benefits when used for an appropriate medical indication.

1. Direct Visualisation

It allows the doctor to examine the inside of the uterus directly rather than relying only on indirect imaging.

2. Minimally Invasive Approach

The hysteroscope is passed through the vagina and cervix, so the procedure generally does not require an abdominal incision.

3. Diagnosis and Treatment

Certain abnormalities can be diagnosed and treated during the same procedure, depending on the findings and the planned approach.

4. Targeted Treatment

Specialised instruments allow the doctor to treat selected abnormalities within the uterine cavity.

5. Recovery at Home

Many hysteroscopy procedures are performed on an outpatient basis, allowing patients to return home on the same day.

6. Support for Fertility Evaluation

When a uterine cavity abnormality is suspected, hysteroscopy can provide information that helps guide further fertility management.

The benefits and recovery time depend on the specific condition being investigated and the type of procedure performed.

What Is the Role of Hysteroscopy in IVF Treatment?

The condition of the uterine cavity is one of several factors considered during fertility treatment. Hysteroscopy may be recommended before or during an IVF treatment plan when investigations suggest a possible abnormality that needs closer examination.

It may help doctors:

• Examine suspected polyps, submucosal fibroids, or intrauterine adhesions.
• Investigate structural abnormalities identified during ultrasound or other imaging.
• Treat certain abnormalities that may affect the uterine cavity.
• Obtain additional information when clinically indicated after previous unsuccessful fertility treatment.

Hysteroscopy is not routinely required before every IVF cycle. Research does not support performing it automatically for every patient when standard investigations are normal.

Whether treating an abnormality improves reproductive outcomes depends on the condition, the individual patient, and the evidence supporting the proposed treatment. Hysteroscopy also does not guarantee successful embryo implantation or pregnancy.

Your fertility specialist can explain whether the procedure is likely to provide useful information or treatment in your particular case.

What Are the Possible Complications of Hysteroscopy?

Hysteroscopy is generally considered safe when performed by appropriately trained healthcare professionals. However, complications can occur, particularly during more complex operative procedures.

Possible complications include:

• Bleeding: Some bleeding or spotting is common after the procedure, but heavy bleeding requires medical assessment.
• Infection: An infection may develop after the procedure, although this is uncommon.
• Uterine perforation: The hysteroscope or a surgical instrument may accidentally create an opening in the uterine wall.
• Fluid-related complications: Absorption of the fluid used to expand the uterus can occasionally cause fluid or electrolyte disturbances.
• Cervical injury: The cervix may be injured during insertion or dilation.
• Injury to nearby organs: Injury to surrounding structures is uncommon but possible, particularly if uterine perforation occurs.
• Intrauterine adhesions: Scar tissue may develop after certain operative procedures.
• Anaesthesia-related complications: Sedation or anaesthesia may carry additional risks depending on the patient’s health and the type of medication used.

The likelihood of complications depends on the procedure, the underlying condition, and individual health factors. Your doctor should explain the relevant risks and benefits before treatment.

If you develop severe pain, heavy bleeding, fever, faintness, or other concerning symptoms after hysteroscopy, contact your healthcare provider promptly.

Hysteroscopy at Jyoti IVF

Hysteroscopy can help investigate and treat selected conditions affecting the uterine cavity. For patients experiencing fertility concerns, it may provide useful information when an abnormality is suspected and help guide an appropriate treatment plan.

At Jyoti IVF, you can discuss your symptoms, previous investigation reports, and fertility goals with a specialist to understand whether hysteroscopy may be suitable for you.

If you have been advised to undergo hysteroscopy or are experiencing difficulty conceiving, consider scheduling a consultation to discuss the procedure, its potential benefits, and the next steps in your care.