Hysteroscopy for Infertility

What is a hysteroscopy?

A hysteroscopy is a procedure in which the doctor uses a hysteroscope to look at the inside of your uterus. A hysteroscope is a thin tube with a tiny camera. The uterus is the muscular organ at the top of the vagina. Babies develop in the uterus, and menstrual blood comes from the uterus.

When is it used?

Hysteroscopy may be done when you are having trouble getting pregnant. For example, it can help the doctor look for scar tissue or a defect in the size or shape of the uterus, such as a double uterus or a septate uterus. In a septate uterus, a thin band of tissue separates the uterus into two compartments. It may also be used to treat polyps or fibroids (tumors) in the uterus, which may be keeping you from getting pregnant.

Examples of alternatives to this procedure are:

• having an ultrasound scan, an exam with high-frequency sound waves
• having a special type of X-ray, such as a hysterosalpingogram (putting dye into the uterus so it can be seen on an X-ray)
• having a D&C (dilation and curettage), in which the doctor opens the cervix and scrapes or suctions tissue from the uterus
• CT scan or MRI
• choosing not to have treatment.

You should ask your doctor about these choices.

It should not be used if you are pregnant, have a pelvic infection, cancer of the uterus or cervix, or recent surgery on the uterus.

How do I prepare for a hysteroscopy?

Plan for your care and recovery after the procedure, especially if you are to have general anesthesia. Allow for time to rest and try to find other people to help you with your day-to-day duties.

Follow your healthcare provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery. Also, your body will heal much better if you do not smoke after the surgery.

Follow any other instructions your provider gives you. If you are to have general anesthesia, eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight or the morning before the procedure. Do not even drink coffee, tea, or water.

Your doctor may put a laminaria (a small piece of seaweed that absorbs moisture) into the cervix the day before the hysteroscopy to help soften and dilate the cervix.

What happens during the procedure?

Hysteroscopy may be done in a doctor's office or in an operating room.

You are given a local, regional, or general anesthetic. A local or regional anesthetic numbs part of your body while you remain awake. It should keep you from feeling pain during the procedure. You may also be given a sedative to relax you. A general anesthetic relaxes your muscles, puts you to sleep, and prevents you from feeling pain.

The doctor dilates (opens) your cervix. The doctor guides the hysteroscope through the cervix into the uterus. The uterus is then inflated with fluid or gas. (This allows the doctor to look at the inside of your uterus more closely.)

What happens after the procedure?

You may stay at your doctor's office or the hospital about 1 or 2 hours. In rare cases you may stay at the hospital overnight.

After the procedure you may:

• feel sleepy or groggy from the anesthetic
• have some cramps
• have trouble urinating the first few hours after the procedure
• have a watery or bloody discharge for 3 or 4 weeks.

Ask your doctor what steps you should take and when you should come back for a checkup.

What are the benefits of this procedure?

The doctor sees the condition of your uterus and may be able to find a reason for infertility. It may be possible to treat the problem at the same time. The procedure is short with a quick and easy recovery.

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. Discuss these risks with your doctor.
• A local or regional anesthetic may not numb the area quite enough and you may feel some minor discomfort. Also, in rare cases, you may have an allergic reaction to the drug used in this type of anesthesia. In most cases, local or regional anesthesia is considered safer than general anesthesia.
• You may have infection and bleeding.
• Rarely, the uterus could be punctured and need surgery to repair it.
• Rarely, the bowel or bladder may be injured.
• You may have an allergic reaction to the fluid used during the procedure.

In general, the procedure poses little risk for most women. You should ask your doctor how these risks apply to you.

When should I call the doctor?

Call the doctor immediately if:

• You start to bleed a lot (like a menstrual period).
• You develop a fever over 100°F (37.8°C).
• You have a lot of pain in your lower abdomen.
• You have a vaginal discharge with a bad odor.

Call the doctor during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.