Hysteroscopy Before IVF: Purpose & Procedure
Fertility TreatmentHysteroscopy is a simple and minimally invasive procedure that can diagnose or/and treat female uterine disorders. This diagnostic treatment method is usually performed under general anesthesia. The doctor inserts a hysteroscope (a thin tube with a small camera) into the vagina to examine the possible disorders of the cervix, vagina, and uterus (such as abnormal vaginal bleeding and painful periods).
Diagnostic hysteroscopy usually may take up to 30 minutes, with no need for hospitalization. Read on to learn about different types of hysteroscopy, how and why it is done, and its best candidates.
What Is a Hysteroscopy?
Hysteroscopy is a diagnostic-operative procedure to examine female genital problems. During this procedure, the doctor inserts a thin tube containing a camera into the uterus through the vagina. In some cases, the uterus may be filled with gas or liquid (carbon dioxide and low-viscosity fluids) to provide a clear field of view for the doctor. The doctor then examines the obtained images to find the cause of infertility and recurrent miscarriage. It should also be mentioned that this procedure is one of the steps of IVF, in which the doctor checks whether the uterus is healthy enough to hold the embryo.
Through hysteroscopy, diagnosing and treating polyps, fibroids, septum, scar tissue, and other abnormalities will be possible. This minimally invasive procedure is also performed in assisted conception methods (such as IVF) along with other examinations and tests such as sperm analysis, FSH and LH tests, and STD tests.
What Are the Different Types of Hysteroscopy?
One of the most common reasons for performing hysteroscopy is to diagnose the cause of abnormal uterine bleeding due to irregular periods.
There are generally two types of hysteroscopy: diagnostic and operative.
Diagnostic Hysteroscopy
Diagnostic hysteroscopy is used to identify uterine problems, diagnose the causes of female infertility, and confirm the results of tests such as hysterosalpingography (HSG or a color x-ray test to evaluate the uterus). This type of hysteroscopy is sometimes done with laparoscopy or before dilation and curettage (D&C).
Some of the common uses of diagnostic hysteroscopy are as follows:
- Finding the cause for repeated miscarriages;
- Examining female infertility and its causes;
- Diagnosing polyps and fibroids (non-cancerous tumors of the uterus);
- Examining the condition of uterus during the IVF process and before embryo transfer;
- Investigating the cause of pelvic pain.
Operative or Therapeutic Hysteroscopy
Operative hysteroscopy is used to treat the identified abnormalities or disorders in diagnostic hysteroscopy, which are sometimes performed together. During a therapeutic hysteroscopy, surgical tools are inserted into the uterus through the hysteroscope to improve uterine disorders.
The most common uses of operative hysteroscopy are as follows:
- Locating an IUD for preventing pregnancy;
- Removing uterine adhesions caused by surgery and infection that will result in absent period and female infertility;
- Performing a biopsy to take a sample of tissue;
- Removing polyps or fibroids.
Why Is Hysteroscopy Done?
Both types of hysteroscopy (operative and diagnostic) are used for various reasons. Some of their uses are to diagnose disorders and confirm other tests. The procedure is also sometimes used to treat gynecological disorders.
The most common reasons for performing hysteroscopy are as follows:
- Diagnosis and treatment of tumors;
- Diagnosis and treatment of endometrial diseases;
- Diagnosis and treatment of uterine malformations;
- Diagnosis and treatment of vaginal bleeding causes;
- Helping the IVF process;
- Dilation and evacuation or D&E.
Other Uses of Hysteroscopy
In general, the common uses of hysteroscopy are as follows:
- Investigating menorrhagia (heavy menstrual bleeding);
- Investigating prolonged menstrual bleeding;
- Measuring postmenopausal bleeding;
- Investigating abnormal bleeding between periods;
- Diagnosing and treating polyps, myomas, fibroids, and intrauterine adhesions;
- Diagnosing the cause of abnormal results from pap smear test;
- Diagnosing symptoms of repeated (more than one) miscarriages;
- Removing the IUD device (a device used for preventing pregnancy);
- Collecting cell samples for biopsy;
- Completing the laparoscopy;
- Diagnosing uterine malformations;
- Re-checking the uterus and scratching the endometrium before embryo transfer;
- Removing the remains of the dead fetus before D & C.
Hysteroscopy before IVF embryo transfer
Hysteroscopy can be used to diagnose the cause of repeated IVF or implantation failure. Also, performing this procedure before IVF may help increase the treatment's success. During a Hysteroscopy, the endometrium is scratched before the embryo transfer, increasing the chance of implantation.
What Is Endometrial Scratching Technique Before IVF?
Endometrial scratching is a widely used technique to increase the chance of pregnancy in women undergoing IVF treatment, during which the inner layer of the uterus is scratched. Endometrial scratching can be performed together with the procedures such as hysteroscopy and endometrial biopsy or can be done alone.
The purpose of endometrial scratching is to cause slight damage to the uterus lining to encourage the body to repair the endometrium by releasing white blood cells and growth factors. This makes the endometrium a better place for embryo implantation. Therefore, the chemicals released during endometrial scratching help the embryo connect to the uterus.
What Is Endometrial Scratching with Hysteroscopy?
Endometrial scratching during hysteroscopy is a surgical procedure that is done vaginally (without making an incision on the abdomen) and under general anesthesia. During this procedure, the doctor can diagnose and treat conditions such as fibroids or polyps as well as create a scratch on the uterus.
The aim of endometrial scratching during hysteroscopy is to increase the success of embryo implantation. The best time to scratch the uterus during hysteroscopy is prior to the embryo transfer stage (day 5 to day 7 of IVF treatment).
How Does Endometrial Scratching Affect the Success of IVF Embryo Transfer?
Endometrial scratching can increase the chance of embryo transfer success in IVF by two times. On the other hand, as endometrial scratching is a minimally invasive procedure with a low risk of pain and infection, it is recommended for patients with high-quality embryos but failed IVF. The reason is that there may be a possibility of endometrium conditions in patients with high-quality embryos who experienced IVF failure.
Although, it should be said that endometrial scratching may not lead to a positive and successful result in women at an advanced age or patients with low-quality and sick embryos (in terms of genetic problems and chromosomal abnormalities). Therefore, it is better to perform pre-implantation genetic tests before endometrial scratching to ensure the health and quality of the embryo and the suitability of this method.
How to Prepare for Hysteroscopy?
Some necessary measures and care that should be done before performing hysteroscopy are as follows:
- Perform all required tests, including pregnancy tests and blood tests;
- Take medicine according to the doctor's advice to check detected fibroids;
- Use contraceptives to prevent pregnancy until the completion of hysteroscopy treatment;
- Take medicines such as ibuprofen around an hour before the surgery to reduce post-surgery pain;
- Prepare for local anesthesia on the cervix;
- Prepare for general anesthesia in cases such as treatment of fibroids with hysteroscopy;
- If general anesthesia is required, stop eating and drinking for a few hours before surgery.
How Is Hysteroscopy Done?
Hysteroscopy does not usually require general anesthesia because no incision is made on the skin except in special cases when the surgery is prolonged and more invasive.
Hysteroscopy may take 5 to 30 minutes, during which the patient wears special clothes and lies on the examination bed. A sedative or general anesthesia is applied according to the doctor's diagnosis, and the procedure begins.
The doctor inserts a small speculum into the vagina, like a pap smear test, to keep the cervix open. Then, a narrow tube called a hysteroscope is inserted. A saline liquid or carbon dioxide gas is slowly released into the uterus to expand the uterus and provide a better view of the inside for the doctor.
The hysteroscope contains a light and a small camera at its end that can send images of the uterus condition, fallopian tubes, and cervix to the monitor. The hysteroscope can also be used where there is a need to collect cell samples for biopsy. If surgery is needed, the surgical instruments are inserted into the uterus through the hysteroscope. Therefore, the doctor can observe the uterine cavity and its surroundings as well as diagnose and treat adhesions and all types of uterine masses.
After Hysteroscopy: What to Expect?
Some aftercare measures should be taken to help speed up the recovery process after hysteroscopy, including:
- Rest for several hours or a day and then return to routine activities;
- Rest for several days in case of having general anesthesia;
- Do not drive after hysteroscopy with general anesthesia;
- Have a healthy diet;
- Be prepared for uterine contractions and abdominal pain (such as menstrual pain), the feeling of gas accumulation in the lower abdomen for up to 24 hours, vaginal spotting and bleeding for several days;
- See a doctor in case of severe pain or abnormal bleeding;
- Avoid sexual intercourse until the bleeding and spotting stop (at least 1 to 2 weeks after the surgery) to reduce the risk of infection;
- Take medications prescribed by the doctor.
What Are the Complications of Hysteroscopy?
Hysteroscopy is a minimally invasive diagnostic and operative method that may become more invasive when combined with other treatment methods.
The complications of hysteroscopy can be as follows:
- Problems caused by anesthesia and general anesthesia;
- Uterine infection;
- Accumulation of fluid and gas in the uterus;
- Embolus caused by electrolyte imbalance;
- Damage to the cervix and the uterus;
- Pelvic inflammatory disease (PID) has symptoms such as severe abdominal pain, fever, and severe vaginal bleeding;
- Uterine perforation (Rare);
- Peritonitis (inflammation in the peritoneum).
Who Are Hysteroscopy Contraindications?
Although hysteroscopy is widely used for diagnosing and treating women's diseases, there are a few absolute contraindications to it due to its possible risks.
Absolute contraindications to hysteroscopy are as follows:
- Pregnant women or those with suspected pregnancy;
- Patients with pelvic infection;
- Women with UTIs (urinary tract infections);
- Women with vaginal infection;
- Women with confirmed uterine cancer.
When Is the Best Time to Perform Hysteroscopy?
The best time to perform a hysteroscopy is one week after the end of the period cycle when the condition of the uterus and other organs is more obvious to the doctor.
It is recommended that patients take birth control pills from day 5 of their period to 2-3 days after the end of menstrual bleeding before performing hysteroscopy. It should be noted that hysteroscopy does not have a time limit for postmenopausal women. If you are getting hysteroscopy to remove fibrosis before starting the IVF process, you should wait two to 12 weeks before starting the cycle.
How Much Does Hysteroscopy Cost?
The cost of diagnostic and operative hysteroscopy depends on the cost of the clinic or hospital, the surgeon's salary, and the cost of complementary and alternative therapies. However, the cost of hysteroscopy is a little higher than open surgery. In Iran, the price of this operation ranges between 1.000 to 2.000 USD, which covers surgeon’s fee, hospital charge, and pre- and post-op medications.
The Bottom Line
Hysteroscopy is an effective and low-risk procedure for diagnosing and treating uterine diseases or abnormalities of the female reproductive system. This procedure is used widely due to its minimal invasiveness and short-term recovery. Although hysteroscopy may cause risks in pregnant women or those suffering from uterine diseases, it is better to use it cautiously.
Frequently Asked Questions About Hysteroscopy
1) Can hysteroscopy cure infertility?
Hysteroscopy can help diagnose and treat infertility causes such as polyps, myomas, and adhesions.
2) Is it possible to get pregnant after a hysteroscopy?
Yes! The chance of pregnancy after hysteroscopy is higher because this procedure can remove uterine tumors and abnormalities and check the health of fallopian tubes.
3) How much do I rest after a hysteroscopy?
Hysteroscopy does not require absolute rest. However, unnecessary activities should be avoided for 24 hours if the patient feels extremely tired. In case of undergoing hysteroscopy surgery (with general anesthesia), it is better to rest for a few days.
4) How long should I wait to do embryo transfer after hysteroscopy?
There is no definite and exact interval of time between hysteroscopy and embryo transfer. The doctor advises this time, depending on the patient's condition. When performing a diagnostic hysteroscopy, the patient can get pregnant immediately in the next IVF cycle. However, it is better to wait at least one or two months before trying to get pregnant if hysteroscopy surgery is done.
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