Hysteroscopy: What to Expect

Hysteroscopy is a procedure used to examine the inside of the uterus. It's a valuable tool in diagnosing and treating various gynaecological conditions, particularly those affecting fertility. If you're considering hysteroscopy in Chennai, this guide will provide you with a comprehensive understanding of the procedure, its benefits, risks, and what to expect.

What Is Hysteroscopy and How Does It Work

Hysteroscopy is a minimally invasive procedure that allows a doctor to look inside the uterus using a thin, lighted tube called a hysteroscope. The hysteroscope is inserted through the vagina and cervix into the uterus. This allows for direct visualization of the uterine lining (endometrium) and any abnormalities that may be present. In my clinical experience, patients often feel anxious about the procedure, but understanding the process can alleviate some of that anxiety.

There are two main types of hysteroscopy:

• Diagnostic Hysteroscopy: This is used to diagnose problems such as abnormal bleeding, infertility, recurrent miscarriages, or suspected abnormalities like polyps or fibroids. It can also be used to investigate the cause of pelvic pain.
• Operative (Surgical) Hysteroscopy: If a problem is detected during a diagnostic hysteroscopy, an operative hysteroscopy can be performed to correct it. This involves using instruments passed through the hysteroscope to remove polyps, fibroids, scar tissue (adhesions), or to take a biopsy of the uterine lining. ESHRE guidelines support hysteroscopy as a key diagnostic tool for intrauterine pathologies.

The procedure works by distending the uterine cavity with a fluid (such as saline) or carbon dioxide gas, which allows for better visualization. The doctor can then examine the uterine lining for any abnormalities. If necessary, small instruments can be passed through the hysteroscope to perform biopsies or remove tissue. Having direct IVF lab expertise, I understand the importance of a healthy uterine environment for successful embryo implantation, and hysteroscopy plays a crucial role in achieving this.

Who Needs Hysteroscopy

Hysteroscopy is recommended for women experiencing a variety of symptoms or conditions, particularly those related to fertility and abnormal uterine bleeding. Some common indications for hysteroscopy include:

• Abnormal Uterine Bleeding: This includes heavy periods (menorrhagia), bleeding between periods (metrorrhagia), or bleeding after menopause. Hysteroscopy can help identify the cause of the bleeding, such as polyps, fibroids, or endometrial hyperplasia (thickening of the uterine lining). NICE guidelines recommend hysteroscopy for women with heavy menstrual bleeding and suspected submucosal fibroids or polyps.
• Infertility: Hysteroscopy can be used to evaluate the uterine cavity in women who are having difficulty conceiving. It can identify and correct abnormalities that may be interfering with implantation, such as polyps, fibroids, scar tissue (adhesions), or uterine septa (a wall dividing the uterus). A meta-analysis showed that RIF patients who underwent hysteroscopy had higher clinical pregnancy rates.
• Recurrent Miscarriages: Women who have experienced multiple miscarriages may benefit from hysteroscopy to identify and correct uterine abnormalities that could be contributing to pregnancy loss.
• Suspected Uterine Abnormalities: If an ultrasound or other imaging test reveals a possible abnormality in the uterus, hysteroscopy can be used to confirm the diagnosis and determine the best course of treatment.
• Removal of Retained Products of Conception: After a miscarriage or childbirth, hysteroscopy can be used to remove any remaining tissue from the uterus.
• Evaluation Before IVF: Many fertility specialists recommend hysteroscopy as part of the evaluation process before starting in vitro fertilization (IVF). This helps to ensure that the uterine cavity is healthy and receptive to embryo implantation. A 2024 meta-analysis found that hysteroscopy increased the chance of pregnancy by 1.59 times (48.1% vs 34.2%) compared to patients without hysteroscopy.

As a fertility specialist practising across multiple locations in Chennai, I often recommend hysteroscopy to patients with unexplained infertility or recurrent implantation failure, as it can significantly improve their chances of a successful pregnancy.

Hysteroscopy Step-by-Step Process

The hysteroscopy procedure typically involves the following steps:

1. Preparation: Before the procedure, you will be asked about your medical history and any medications you are taking. You may be advised to take a pain reliever such as ibuprofen or paracetamol before the procedure to help minimize discomfort. In my experience, discussing any concerns with your doctor beforehand can help ease anxiety.
2. Anesthesia: Hysteroscopy can be performed with or without anesthesia, depending on the type of procedure and your individual preferences. Diagnostic hysteroscopy is often performed in the office with local anaesthesia or no anaesthesia at all. Operative hysteroscopy may require regional or general anaesthesia.
3. Positioning: You will lie on your back on an examination table with your feet in stirrups, similar to a pelvic exam.
4. Insertion of the Hysteroscope: The doctor will gently insert the hysteroscope through your vagina and cervix into your uterus. A fluid or gas will be used to expand the uterine cavity for better visualization.
5. Examination of the Uterus: The doctor will carefully examine the uterine lining for any abnormalities. If a problem is detected, a biopsy may be taken, or instruments may be passed through the hysteroscope to perform a surgical procedure.
6. Completion: Once the examination or procedure is complete, the hysteroscope is removed.

The entire process usually takes between 15 and 60 minutes, depending on the complexity of the case. After the procedure, you will be monitored for a short time before being discharged. The recovery is usually quick, and most women can return to their normal activities within a day or two.

Success Rates of Hysteroscopy

The success rates of hysteroscopy depend on the specific condition being treated and the type of procedure performed. In general, hysteroscopy is a highly effective procedure for diagnosing and treating uterine abnormalities.

• For Diagnosis: Hysteroscopy is very accurate in diagnosing uterine abnormalities such as polyps, fibroids, and scar tissue. Studies have shown that hysteroscopy has a high sensitivity and specificity for detecting these conditions.
• For Treatment of Polyps and Fibroids: Hysteroscopic removal of polyps and fibroids is generally very successful. The recurrence rate is low, although it can vary depending on the size and location of the polyp or fibroid.
• For Treatment of Asherman's Syndrome (Scar Tissue): Hysteroscopic removal of scar tissue can improve fertility and reduce the risk of miscarriage in women with Asherman's syndrome. However, the success rate depends on the severity of the scarring.
• For Improving IVF Success: Hysteroscopy performed before IVF can improve implantation rates and pregnancy rates in women with uterine abnormalities. A 2024 meta-analysis indicated a live birth rate increase of 1.30 times (41.2% vs 33.9%) based on 5 studies (2277 participants).

It's important to note that success rates can vary depending on individual factors such as age, overall health, and the presence of other fertility problems.

Hysteroscopy Cost in Chennai

The cost of hysteroscopy in Chennai can vary depending on several factors, including:

• Type of Hysteroscopy: Diagnostic hysteroscopy is typically less expensive than operative hysteroscopy.
• Location: The cost may vary depending on whether the procedure is performed in a private hospital, a clinic, or an outpatient surgical centre.
• Anesthesia: The type of anesthesia used (local, regional, or general) will affect the cost.
• Surgeon's Fees: The fees charged by the surgeon can vary depending on their experience and expertise.

As a general estimate, the cost of hysteroscopy in Chennai can range from ₹15,000 to ₹40,000. Here's a breakdown:

It is important to discuss the cost of hysteroscopy with your doctor and the facility where the procedure will be performed to get a clear understanding of the total expenses involved. Many hospitals and clinics offer payment plans or financing options to help make the procedure more affordable.

Risks and Side Effects

Hysteroscopy is generally a safe procedure, but like all medical procedures, it carries some risks and potential side effects. These include:

• Infection: There is a small risk of infection after hysteroscopy. Symptoms of infection may include fever, chills, pelvic pain, and foul-smelling vaginal discharge.
• Bleeding: Some bleeding is normal after hysteroscopy, but heavy bleeding is rare.
• Uterine Perforation: In very rare cases, the hysteroscope can puncture the wall of the uterus. This is more likely to occur in women who have had previous uterine surgery or who have a weakened uterine wall.
• Adverse Reaction to Anesthesia: Some women may experience an allergic reaction to the anesthesia used during the procedure.
• Cervical Injury: The cervix can be injured during the insertion of the hysteroscope.
• Fluid Overload: If a large amount of fluid is used to distend the uterus, it can lead to fluid overload, which can cause problems with the heart and lungs.

The risk of serious complications from hysteroscopy is low, estimated to be less than 1%. Most women experience only mild side effects such as cramping, spotting, and mild pelvic pain, which usually resolve within a day or two.

What to Expect After Hysteroscopy

After hysteroscopy, you can expect the following:

• Recovery: Most women can return to their normal activities within a day or two. You may experience some mild cramping or spotting for a few days.
• Pain Management: Over-the-counter pain relievers such as ibuprofen or paracetamol can help relieve any discomfort.
• Hygiene: It is important to maintain good hygiene after hysteroscopy to prevent infection. Avoid using tampons or douching for at least a week.
• Follow-Up: Your doctor will schedule a follow-up appointment to discuss the results of the hysteroscopy and any necessary treatment.

It is important to contact your doctor if you experience any of the following symptoms after hysteroscopy:

• Fever or chills
• Severe pelvic pain
• Heavy bleeding
• Foul-smelling vaginal discharge

Following your doctor's instructions carefully after hysteroscopy can help ensure a smooth and uneventful recovery. A meta-analysis (2025) found that performing embryo transfer within 120 days after adhesiolysis or polypectomy, and within 50 days after diagnostic hysteroscopy, was associated with superior outcomes.

When to Seek Professional Help

Hysteroscopy is a valuable tool for diagnosing and treating uterine abnormalities that can affect fertility and overall gynaecological health. While this guide provides general information, it is not a substitute for professional medical advice. If you are experiencing symptoms such as abnormal uterine bleeding, infertility, or recurrent miscarriages, it is important to consult with a qualified fertility specialist in Chennai for personalized evaluation and treatment. For personalised guidance, book a consultation with Dr. Rukkayal Fathima.