A Guide to Understanding Hysteroscopy

By Constance McGraw, MPH

What is a hysteroscopy?

Hysteroscopy is a medical procedure that helps healthcare providers examine a woman's uterus using a thin, illuminated tube called a hysteroscope. Hysteroscopy is the preferred procedure for both diagnosing (diagnostic hysteroscopy) and treating (operative hysteroscopy) uterine issues.

When and why hysteroscopies are performed

Hysteroscopies are typically performed for the following reasons:

• To determine reasons for infertility
• To determine the cause of recurrent miscarriages
• To determine the causes of abnormal uterine bleeding
• To locate an intrauterine device (IUD)
• To treat pelvic pain
• To remove adhesions from previous surgery or infections
• To place small implants into a woman's fallopian tubes as a permanent form of birth control (sterilization)
• To treat bleeding after menopause

The hysteroscopy procedure 

• Hysteroscopy takes place in a healthcare office or hospital when you're not on your period.
• Prior to a hysteroscopy, you might receive medication to relax or anesthesia to put you to sleep.
• To ease the procedure, your cervix might be opened (dilated) using medication or special tools. 
• A speculum goes into the vagina, followed by a hysteroscope inserted through the cervix into the uterus. 
• Carbon dioxide or saline is used to expand the uterus for a clearer view. The fluid amount is monitored. 
• Your healthcare provider uses the hysteroscope to view your uterus lining and fallopian tube openings. If needed, small tools can be inserted for a biopsy or other procedures.
• If adhesions are removed, dilation and curettage will occur, where your doctor uses a curved tool called a curette to gently scrape tissue from your uterus.

Hysteroscopy is generally performed as an outpatient procedure, and you should be able to go home afterward; however, if you received general anesthesia, you may need to wait until you are less groggy to return home.

Recovery after hysteroscopy

After hysteroscopy, it is normal to have some mild cramping or light bleeding for a few days and up to a week. Additionally, some patients report pain from gas in the digestive tract. Medication may be provided for pain control. In the unlikely event of a fever or heavy bleeding, call your healthcare professional immediately.

Risks with hysteroscopy

Hysteroscopy is generally a very safe procedure; however, there are a few risks. The number of problems that people experience post hysteroscopy can vary widely and have been reported as <1% of patients in several studies. Of those complications, the most commonly reported include hemorrhage (2.4%), uterine perforation (1.5%), and cervical laceration (1–11%). Nonetheless, the majority of research indicates a high level of safety and patient satisfaction following operative hysteroscopy. 

Hysteroscopy in infertility 

Hysteroscopy is an important part of infertility examinations. A hysteroscopy helps find growths like fibroids, polyps, and adhesions in the uterus, which are common in women of reproductive age, representing 2-3% of causes of infertility. Growths can cause infertility by getting in the way of the implementation and growth of an embryo in the womb. In fact, studies show that the most common uterine abnormalities are detected by hysteroscopy in 10-15% of women who are looking for medical treatment for infertility. 

Hysteroscopy before IVF

In addition to detecting abnormalities in the uterus, hysteroscopy prior to IVF has been suggested to improve IVF success rates. A Cochrane systematic review revealed that in women undergoing IVF, the included studies showed that performing a screening hysteroscopy first improved the chances of live birth or clinical pregnancy. More specifically, for women trying to conceive at a traditional fertility clinic with a 22% live birth rate, a screening hysteroscopy may potentially increase live birth rates to 25%- 32% without raising the risk of miscarriage. 

However, it's important to understand that the quality of these studies was poor, and there is also a lack of evidence regarding any problems that might happen during or after a hysteroscopy. Higher-quality studies are needed to determine the usefulness and safety of hysteroscopy before IVF.

Working with your healthcare professional to determine the best tools for you in screening for potential intrauterine issues is necessary. Find fertility specialists near you If you are looking for a second opinion or need to do fertility testing.

References:

1. The American College of Obstetricians and Gynecologists (ACOG) 2018. Hysteroscopy. Retrieved November 2023 from: https://www.acog.org/womens-health/faqs/hysteroscopy.
2. Di Spiezio Sardo A, Di Carlo C, Minozzi S, et al. Efficacy of hysteroscopy in improving reproductive outcomes of infertile couples: a systematic review and meta-analysis. Hum Reprod Update. 2016;22(4):479-496. doi:10.1093/humupd/dmw008.
3. Gulisano M, Gulino FA, Incognito GG, et al. Role of hysteroscopy on infertility: the eternal dilemma. Clin. Exp. Obstet. Gynecol. 2023, 50(5), 99. doi:10.31083/j.ceog5005099.
4. Zikopoulos A, Galani A, Siristatidis C, et al. Is hysteroscopy prior to IVF associated with an increased probability of live births in patients with normal transvaginal scan findings after their first failed IVF trial? J Clin Med. 2022;11(5):1217. doi:10.3390/jcm11051217.
5. Kamath MS, Bosteels J, D'Hooghe TM, et al. Screening hysteroscopy in subfertile women and women undergoing assisted reproduction. Cochrane Database of Systematic Reviews 2019, Issue 4. Art. No.: CD012856. DOI: 10.1002/14651858.CD012856.pub2. Accessed 08 November 2023.
6. Elahmedawy H, Snook NJ. Complications of operative hysteroscopy: an anaesthetist's perspective. BJA Educ. 2021;21(7):240-242. doi:10.1016/j.bjae.2021.03.001.
7. Jansen FW, Vredevoogd CB, van Ulzen K, et al. Complications of hysteroscopy: a prospective, multicenter study. Obstet Gynecol. 2000;96(2):266-270. doi:10.1016/s0029-7844(00)00865-6.