Hysteroscopy for Infertility
View of normal uterine cavity at hysteroscopy (office hysteroscopy with a 2.7 mm scope)
We are looking up at the top of the uterine cavity (fundus)
The tip of the scope is just above the junction of the cervix and uterus (internal os)
The left tubal opening (ostia) is the dark spot at 3 o'clock
The right tubal opening is seen at 9 o'clock
Hysteroscopic view of a uterine septum
A septum can cause recurrent miscarriage
Hysteroscopy is a procedure that involves insertion of a narrow telescope-like instrument through the vagina and cervix into the cavity of the uterus (endometrial cavity). The uterine cavity is then distended with fluid and visualized.
What is hysteroscopy used for?
This procedure allows us to see if there are any uterine cavity defects such as:
- Fibroid tumors
- Endometrial polyps
- Intrauterine scar tissue
- A bicornuate uterus or septate uterine malformation
- Other uterine problems
If any defects are found then they should be corrected with operative hysteroscopy which involves placing instruments through ports in the scope that allow us to cut, cauterize, etc. to correct the problem.
Ultrasound with saline - hydrosonogram - shows uterus, endometrial cavity
(black area in middle), and polyp (between cursors)
Hysteroscopic view of same polyp at the time of resection procedure
A large polyp at the top of the uterine cavity
The same polyp being resected with hysteroscopic scissors
Is it a big procedure? How much work would I miss?
Hysteroscopy is an out-patient procedure that is usually done in a hospital but can also be done in the office. The actual procedure (diagnostic) usually takes 2-5 minutes.
No anesthesia at all is needed for most cases of diagnostic hysteroscopy if a microhysteroscope (scope diameter less than 5mm) is used.
General anesthesia or local anesthesia can be used if any operative work is required.
Usually the woman is discharged home approximately 15-30 minutes after the procedure. She can return to work the next morning if general anesthesia was used, or immediately if no anesthesia (or local) was used. Mild pain and cramping is common after operative hysteroscopy, but it usually is brief (lasting perhaps 30 minutes, possibly up to 8 hours).
What problems can defects of the uterine cavity cause?
Abnormalities of the endometrial cavity can be responsible for infertility or problems with recurrent miscarriage.
Hysteroscopy and other methods, such as a hysterosalpingogram, ultrasound, or ultrasound with saline test are useful in diagnosing and correcting these defects.
Complications associated with hysteroscopy include the possibility of infection, uterine perforation, vaginal bleeding, and fluid overload.