Hysteroscopy
What is a Hysteroscopy?
Hysteroscopy is a minimally invasive gynecological procedure that allows the gynecologist to directly examine the inside of the uterus. It is performed by inserting a hysteroscope through the cervix, without requiring any incision in the skin.
The hysteroscope is equipped with a small camera that transmits images to a monitor, allowing the gynecologist to accurately assess the uterine cavity, the endometrium, and the openings of the fallopian tubes. Depending on the purpose of the procedure, it can be used for both the diagnosis and treatment of pathological conditions.
Diagnostic and therapeutic hysteroscopy
Hysteroscopy is classified into two main types depending on its purpose:
Diagnostic hysteroscopy
It is performed exclusively to examine and evaluate the uterine cavity. It allows for the detection of polyps, fibroids, adhesions, septa, or pathological changes in the endometrium that are not always visible on ultrasound. It is a brief procedure often performed under mild general anesthesia or sedation.
Invasive Hysteroscopy
It combines diagnosis and treatment in a single procedure. Using specialized instruments inserted alongside the hysteroscope, the gynecologist can remove polyps, submucosal fibroids, intrauterine devices, or adhesions, perform an endometrial biopsy, and induce controlled endometrial damage to improve embryo implantation in the context of in vitro fertilization. It is usually performed under general anesthesia.
When is a hysteroscopy recommended?
Hysteroscopy is recommended for a wide range of clinical conditions:
Diagnostic indications
Abnormal vaginal bleeding or postmenopausal bleeding, suspicious findings on gynecological ultrasound such as a thickened endometrium or suspicious masses, investigation of recurrent miscarriages, and evaluation of congenital uterine anomalies.
Therapeutic Indications
Removal of endometrial polyps, removal of submucosal fibroids, lysis of intrauterine adhesions (Asherman’s syndrome), removal of an intrauterine device, endometrial biopsy, and removal of residual tissue from a previous pregnancy.
In the context of assisted reproduction
Hysteroscopy is an important diagnostic and therapeutic tool in the investigation of infertility and in preparation for in vitro fertilization, particularly in cases of recurrent implantation failure.
Preparing for a Hysteroscopy
Timing
Hysteroscopy is usually scheduled during the first half of the menstrual cycle, ideally between the 6th and 12th day, immediately after the end of menstruation.
Preoperative Tests
Before an invasive hysteroscopy, the gynecologist may request basic blood tests, an electrocardiogram, and an anesthesiological evaluation if the procedure is performed under general anesthesia.
Preoperative Instructions
If general anesthesia is used, you must fast for at least 6 hours before the procedure. It is also recommended that you avoid sexual intercourse and the use of vaginal preparations for 2 to 3 days beforehand. Inform your doctor of any medications you are taking, especially anticoagulants or anti-inflammatory drugs.
How it works & duration
Anesthesia
Depending on the type of procedure and the patient’s needs, local anesthesia, sedation, or general anesthesia may be used. Diagnostic hysteroscopy is often performed with minimal anesthesia, while the surgical procedure usually requires general anesthesia.
Procedure
First, the gynecologist carefully inserts the hysteroscope through the cervix into the uterine cavity. A small amount of fluid (usually saline) is then injected to distend the cavity and improve visualization. The gynecologist systematically examines the endometrium and the openings of the fallopian tubes, and if it is an operative hysteroscopy, proceeds to treat the identified condition.
Duration
Diagnostic hysteroscopy usually lasts 10 to 20 minutes. An invasive hysteroscopy can last from 20 to 60 minutes, depending on the complexity of the procedure. In most cases, the patient can return home the same day.
Recovery after a hysteroscopy
In most cases, there are few to no symptoms, and recovery is very rapid.
In the first few days, it is normal to experience mild cramping or a feeling of pressure in the pelvic area, which subsides within 1 to 2 days with simple pain relievers.
Also, light bleeding or spotting is completely normal and can last from a few days to 2 weeks.
It is recommended that you avoid sexual intercourse, tampons, and vaginal douches for at least 2 weeks after the procedure. Daily activities can be resumed within 1 to 2 days.
Complications
Hysteroscopy is one of the safest gynecological procedures, and complications are rare. The most common complications include infection of the uterus or fallopian tubes, which is treated with antibiotics, and prolonged bleeding, which usually resolves without intervention.
In rare cases, uterine perforation or the formation of intrauterine adhesions may occur during healing.
The risk of serious complications is extremely low when the procedure is performed by a specialized gynecologist with experience in hysteroscopic surgery.
Post-IVF Follow-Up
Diagnostic evaluation prior to IVF
Before an in vitro fertilization (IVF) cycle, hysteroscopy allows for the identification and treatment of pathological conditions that may negatively affect embryo implantation, such as polyps, submucosal fibroids, intrauterine adhesions, or septa. We also assess for signs of chronic endometritis and perform a microbiome analysis. Chronic endometritis is a very common cause of implantation failure or miscarriage in both natural conception and during in vitro fertilization.
Controlled Endometrial Injury (Implantation Cuts)
It is well documented in the literature that controlled endometrial injury improves implantation rates. During hysteroscopy, small transverse incisions are made in the uterine fundus. The result of this “endometrial trauma” is the activation of healing mechanisms that improve the endometrium’s receptivity to implantation. It is worth noting that spontaneous pregnancies are often observed immediately following such a hysteroscopy.
Recurrent Implantation Failure
In women who have experienced recurrent implantation failure despite the presence of good-quality embryos, hysteroscopy is a key investigative step. It often reveals abnormalities that were not visible on ultrasound, and treating them can significantly improve the prognosis.
Frequently Asked Questions (FAQ)
It is generally recommended to wait for 1 to 2 full menstrual cycles after an invasive hysteroscopy before embryo transfer. This allows for the endometrium to fully recover and reach optimal receptivity. In some cases, the gynecologist may recommend a different timeline depending on the findings of the procedure.
In most cases, the next menstrual period occurs at the expected time. Some women may experience a slight delay or a change in the flow of their first period after the procedure, which is completely normal. If the delay exceeds 6 weeks, it is advisable to contact your gynecologist.
Yes, some women experience mild bloating in the abdominal area during the first few days after the procedure. This is due to the fluid or CO2 used to distend the uterine cavity and subsides on its own within a few days without requiring any intervention.
Light bleeding or spotting after a hysteroscopy is completely normal and usually lasts from a few days to 2 weeks, depending on the type of procedure. If the bleeding is heavy, resembles a heavy period, or lasts longer than 2 weeks, contact your gynecologist.
The cost varies depending on the type of procedure, as well as the type of anesthesia and the hospital or clinic where it is performed. For detailed information about costs and available options, please contact our office.
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