A Closer Look Inside the Uterus Could Make an Important Difference

You have completed your fertility investigations, your IVF cycle is planned, and you are preparing for embryo transfer. Then your doctor suggests one more procedure: Hysteroscopy.

Naturally, questions arise. Why do I need another test? Wasn't my ultrasound normal? Can something be missed on a scan? Will hysteroscopy improve my chances of pregnancy?

Let's understand why your fertility specialist may recommend looking inside the uterus before IVF.

What is Hysteroscopy?

Hysteroscopy is a minimally invasive procedure that allows your gynaecologist to directly examine the inside of your uterus using a thin, lighted telescope-like instrument called a hysteroscope.

The instrument is gently passed through the vagina and cervix into the uterine cavity. Saline is used to gently expand the cavity, allowing the doctor to examine the uterine lining and identify abnormalities.

Unlike an ultrasound, hysteroscopy provides a direct view of the uterine cavity. It can also allow treatment of certain abnormalities during the same procedure.

Why is the Uterine Cavity Important in IVF?

Think of the uterus as the place where an embryo needs to settle and develop. For successful implantation, the uterine cavity should ideally have a suitable shape and a healthy lining.

Even when embryo quality is good, abnormalities inside the uterine cavity may sometimes interfere with implantation or contribute to pregnancy loss. This is why evaluating the uterine cavity is an important part of fertility assessment.

What Conditions Can Hysteroscopy Detect Before IVF?

When Is Hysteroscopy Recommended Before IVF?

Hysteroscopy is particularly useful in selected situations:

• Abnormal ultrasound or 3D ultrasound findings.
• Repeated implantation failure (RIF) during prior IVF cycles.
• Recurrent pregnancy loss (RPL).
• Previous uterine procedures (such as curettage or retained products removal).
• Abnormal menstrual history (very scanty periods or sudden flow changes).
• Persistent unexplained bleeding.

My Ultrasound Is Normal. Do I Still Need Hysteroscopy?

A good-quality transvaginal ultrasound, saline infusion sonography (SIS), or 3D ultrasound provides valuable information. However, some small polyps, fine adhesions, and subtle cavity abnormalities may not always be clearly identified on routine imaging.

Remember: Hysteroscopy is not compulsory for every woman undergoing IVF. Evidence does not support performing routine hysteroscopy in all women with a normal uterine cavity simply to improve IVF success rates. The decision must be individualized.

Can Hysteroscopy Improve IVF Success Rates?

The answer depends on what is found. If a significant cavity abnormality is detected and appropriately treated, correcting it may improve the uterine environment and reproductive outcomes in selected patients. However, hysteroscopy itself is not a cure-all for every cause of implantation failure.

What Happens During Hysteroscopy?

Hysteroscopy may be performed as a diagnostic or operative procedure under general anaesthesia depending on individual circumstances. The procedure generally takes around 15–30 minutes.

1. Preparation and pre-anaesthesia assessment.
2. Administration of planned anaesthesia.
3. Gentle passage of the hysteroscope through the cervix.
4. Expansion of the uterine cavity using saline.
5. Examination and identification of abnormalities.
6. Removal of selected polyps, adhesions, or lesions if indicated.

Is Hysteroscopy Safe? What About Recovery?

Hysteroscopy is generally safe when performed by a trained specialist. Some women may experience mild period-like cramps, light vaginal bleeding, or spotting for a few days. Rare complications include infection or uterine perforation.

5 Questions to Ask Your Fertility Specialist Before Hysteroscopy

1. What is the specific reason you are recommending hysteroscopy?
2. Was anything abnormal detected on my ultrasound or 3D scan?
3. Can the suspected abnormality be treated during the same procedure?
4. Will the findings change my IVF or embryo-transfer plan?
5. How long should I wait before proceeding with embryo transfer?