Cervical canal: normal / stenosis
Whether the passage through the cervix is open or narrowed.
- Reference
- Normal: canal open.
Home › Tests › Hysteroscopy
TESTS · HYSTEROSCOPY
A camera inside sounds like surgery. Often it's a short look.
Hysteroscopy is a thin camera passed through the cervix to see the inside of the womb directly. It answers one question: is anything in the cavity that could stop an embryo implanting?
- When a scan or HSG suggests a problem
- 5 to 10 minutes to look
- Findings the same day
- After your period, before ovulation
- Cervix — The camera goes in this way, with no cut
- Cavity — Fluid gently opens it so the walls can be seen
- Polyp or fibroid — Can often be removed in the same sitting
- Tube openings — Both should be seen
01What is a hysteroscopy, and why is it done for infertility?
A hysteroscopy is a look inside the womb with a thin telescope and camera passed through the vagina and cervix, so there is no cut, no scar and usually no overnight stay.
Salt water gently opens the cavity so the walls can be seen. It is advised when a scan, saline scan or HSG suggests something inside the womb, after repeated miscarriage or failed embryo transfers, or with abnormal bleeding. It shows the inside of the womb only; the tubes and ovaries need other tests.
02What is the difference between diagnostic and operative hysteroscopy?
A diagnostic hysteroscopy only looks; an operative hysteroscopy uses fine instruments through the same camera to treat what is found.
Polyps are removed, fibroids inside the cavity shaved away, scar bands divided, a septum cut, or a lost coil retrieved. Often the two are planned together: we look, with your consent agreed beforehand to treat what we find. That saves you a second procedure.
03What does a hysteroscopy feel like?
Most women feel period-like cramping while the womb is filled, which settles soon after the camera is out; some feel very little, and some find it genuinely painful.
Done awake, a painkiller an hour before helps, and a local anaesthetic can be given around the cervix. You can ask to stop at any point, and it can be rescheduled under anaesthesia; that is a valid choice, not a failure. Expect cramping for a day or two and light spotting for up to a week. Fever, heavy bleeding, smelly discharge or worsening pain needs a same-day check: call us on +91 89399 94244; outside clinic hours, call 108 or go to the nearest emergency department, then call us.
04When in the cycle is it done?
Hysteroscopy is done after your period stops and before ovulation, usually between day 6 and 11, when the lining is thin and easy to see.
It is not done if there is any chance you are pregnant. Tell us beforehand about blood thinners, previous cervical surgery, latex allergy, or fainting during a smear or coil fitting, because each changes how it is set up.
05Do I need a hysteroscopy before IVF?
Not routinely: if your scan shows a normal cavity, a hysteroscopy before IVF has not been shown to improve the chance of a baby.
Large trials tested routine hysteroscopy before IVF in women with a normal scan and found no benefit in live births. It is worth doing when there is a reason to suspect a problem: a scan finding, repeated failed transfers or miscarriages. If it is suggested to you, ask what question it is expected to answer.
Honest note
Routine hysteroscopy before every IVF is not supported by evidence. NICE advises against hysteroscopy unless a problem in the womb or its lining is suspected, and ESHRE does not recommend it for all IVF patients. (NICE NG257; ESHRE add-ons recommendations, 2023)
How to read your report
Bring your hysteroscopy report and any biopsy result. We read them with you, line by line.
Uterine cavity: normal size and shape
The inside of the womb looks a normal shape with nothing growing into it.
- Reference
- This is the normal finding.
Endometrium: normal / thin / polypoidal / hyperaemic
How the lining looks: normal, thin, bumpy, or red and inflamed.
- If outside
- Red, inflamed lining may point to chronic endometritis; a biopsy checks it.
Bilateral tubal ostia seen
Both openings where the tubes join the womb were seen.
- Reference
- Normal: both seen. This does not show the tubes are open.
Endometrial polyp, removed (polypectomy)
A soft overgrowth of the lining was found and taken out.
Submucous fibroid, FIGO type 0, 1 or 2
A fibroid bulging into the cavity. Type 0 sits inside the cavity; type 1 is less than half in the wall; type 2 is half or more in the wall.
- Reference
- Classification: FIGO fibroid system.
- If outside
- Fibroids that distort the cavity are the ones most worth removing before treatment.
Intrauterine adhesions / synechiae (Asherman syndrome)
Scar bands inside the womb, often after a D&C or infection.
- If outside
- Divided at hysteroscopy; a repeat look is common because scars can re-form.
Septum / arcuate uterus
A wall of tissue dividing the cavity (septum), or a shallow dip at the top (arcuate, usually harmless).
Endometrial biopsy sent for HPE / CD138
A sample of lining sent to the lab. HPE is the microscope report; CD138 is a stain used to look for chronic endometritis.
- Reference
- The lab report gives its own reference; there is no single agreed cut-off for CD138.
Source of ranges: Findings are described in words, not numbers. Fibroid types follow the FIGO classification. When hysteroscopy is advised follows NICE NG257 and the ASRM fertility evaluation committee opinion (2021).
What the result changes
IfNormal cavity
The womb is ruled out as a cause. We move on with the plan: IUI, IVF or a frozen transfer, without repeating the look.
What that meansIfPolyp or small fibroid, removed
Treatment can usually go ahead in the next cycle or two, once the lining has recovered.
What that meansIfScar tissue (adhesions)
Divided at the same sitting. A follow-up look may be planned before an embryo transfer, because scars can re-form.
What that meansIfSeptum
Divided in a short operative hysteroscopy, especially after miscarriage. We talk through what the evidence does and doesn't show.
What that meansIfInflamed lining (possible chronic endometritis)
Biopsy first; if confirmed, a course of antibiotics before an embryo transfer.
What that meansDo you need this test?
A hysteroscopy is worth discussing if one of these is you.
- My scan showed a polyp or fibroid
- My HSG showed a gap in the womb outline
- I've had more than one miscarriage
- Good embryos haven't implanted
- I've had a D&C and my periods got lighter
- Heavy or irregular bleeding between periods
Scan normal and just starting IVF? You probably don't need one. See what else the womb can hide.
Your first visit
1
Talk
Your scans, bleeding pattern, past miscarriages, D&C or failed transfers.
2
Test
A scan or saline scan first. Hysteroscopy only if it shows, or strongly suggests, a problem.
3
Plan
What will be looked for, what may be removed, and which route suits you (awake or anaesthesia).
4
Treat
Hysteroscopy on day 6 to 11, then your fertility treatment once the lining has recovered.
Questions patients ask
Is hysteroscopy painful?
Hysteroscopy usually causes period-like cramping that settles quickly, though some women find it painful when done awake. A painkiller beforehand and local anaesthetic help, and you can stop at any time and have it under anaesthesia instead.
Do I need a hysteroscopy before IVF?
Not if your scan shows a normal womb cavity; routine hysteroscopy before IVF has not been shown to improve the chance of a baby. It is worth doing when a scan, HSG or your history suggests a problem inside the womb.
How soon can we try to conceive after a hysteroscopy?
After a diagnostic hysteroscopy you can usually try in the same cycle. After polyps, fibroids or scar tissue are removed, it is usually one or two cycles, so the lining can recover.
Is hysteroscopy the same as a D&C?
No. A D&C scrapes the lining without seeing it; hysteroscopy looks first and treats only what is actually there.
Will a hysteroscopy affect my eggs or AMH?
No, a hysteroscopy does not touch the ovaries, so it does not affect your egg reserve or AMH.
Can a hysteroscopy be done during my period?
It should be done after your period stops, because blood blurs the view. If you are bleeding heavily on the day, it is usually rescheduled.
What are the risks of hysteroscopy?
Serious problems after hysteroscopy are uncommon. The main risks are infection, bleeding and, rarely, a small tear in the womb wall, more likely in longer operative procedures; most heal without further surgery.
Off the Record
Not the question you had?
The questions people don't ask with their partner sitting beside them, answered by Dr Vani Sundarapandian.
In their words, not ours.
Ragul Mohan
· September 2023Good hospitality and treatment, Doctors are helpfull and responding patiently, special thanks to Vani mam, Mangalam mam and sunaena mam for their wonderful treatment.
Prabal Sur
· September 2023We thank Dr.Prema Mam for her support in this journey. She is very calm and composed.
Sources (5)
- NICE: Investigation of fertility problems and management strategies, Fertility problems: assessment and treatment (NG257)
- ESHRE (Human Reproduction): Good practice recommendations on add-ons in reproductive medicine (2023)
- RCOG: Outpatient hysteroscopy (patient information)
- NHS: Hysteroscopy
- ASRM: Fertility evaluation of infertile women: a committee opinion (2021)
Ask what it will answer, before you book it.
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