Hysteroscopy Explained: How It Helps Diagnose and Treat Infertility

In short: Hysteroscopy lets the doctor see the cavity of the uterus directly through the cervix, with no cut in the abdomen. It is used to diagnose and treat abnormal bleeding, adhesions inside the uterus, polyps and abnormalities such as a septum, and to locate or remove an IUD; it is important in assessing infertility. A diagnostic procedure takes about half an hour and an operative one up to two hours, and may be followed by mild cramps and slight bleeding.

What is hysteroscopy?

Hysteroscopy is a minimally invasive procedure in which your surgeon gently passes a thin telescope-like instrument, called a hysteroscope, through the cervix (neck of the womb) into the uterine cavity. A fluid or gas is used to gently expand the cavity, allowing a clear view of the inside of the uterus using a light source for illumination. Special instruments can then be used to treat many conditions during the same procedure.

For infertility, hysteroscopy is most useful when an ultrasound or other test suggests a problem inside the uterus (such as a polyp, fibroid, adhesions or septum). If the uterine cavity looks normal on ultrasound, routine hysteroscopy before IVF has not been shown to improve pregnancy rates.

Some instruments used in hysteroscopy

Indications of hysteroscopy

Abnormal Menstrual Loss:

Hysteroscopy allows your doctor to identify and often treat the cause of abnormal uterine bleeding.

This bleeding could be due to benign growths or, less commonly, malignant ones.

Large tumors within the uterine cavity may also contribute to miscarriage.

Intrauterine Adhesions:

These adhesions may develop after uterine infections, previous curettage procedures, or other surgery involving the uterine cavity.

Over time, the walls of the uterus can stick together, which may lead to miscarriage, infertility, or irregular periods.

Hysteroscopy plays an important diagnostic role and can also help treat these adhesions.

• Sub-mucous Fibroids and Endometrial Polyps

Uterine Septum:

A uterine septum can be associated with infertility, recurrent miscarriage, or premature labour. During hysteroscopy, the septum can be carefully cut or cauterized to help restore a more typical uterine shape. Recent studies disagree on how much this improves the chance of a live birth, so the decision is made case by case after discussion with your doctor.

Hysteroscopic uterine septum resection for recurrent miscarriage

Missed IUD:

Although uncommon today, the retrieval thread of an intrauterine device can sometimes be cut or lost. In these cases, hysteroscopy can help locate and safely remove the IUD.

Endometrial Resection:

This procedure is considered only for women with heavy periods who have completed their family and in whom medical treatment has not helped. It is not suitable for women who wish to become pregnant, because it destroys the lining of the womb; irregular bleeding should always be investigated first.

Afterwards, most patients notice much lighter periods, and in many cases periods stop altogether.

After the hysteroscopy operation the patient may feel:

Mild discomfort in the lower abdomen and some light vaginal spotting is normal. Most patients only need one day of rest, but please reach out to your doctor if you feel concerned or have any questions.

If you have questions about hysteroscopy or think it may help with your fertility journey, the team at Dr. Najeeb Layyous’ clinic is here to guide you through your options with care.

Dr Najeeb Layyous F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist