Hysteroscopy Before IVF: Why It Is Recommended for Fertility Treatment

What is Hysteroscopy?

Hysteroscopy is a minimally invasive procedure in which doctors use a thin, lighted instrument called a hysteroscope, gently inserted into the uterus through the cervix. This provides a clear view of the inside of the uterus and the endometrial cavity. A special fluid is used to expand the uterus, allowing the area to be seen more clearly. The type of fluid depends on the technique and instrument used during the procedure.

Doctors carefully monitor the amount of fluid to prevent complications such as fluid overload and ensure the procedure is safe. The recommended fluid deficit limit is 1000 mL to reduce the risk of fluid overload.

Key Indications for Performing Hysteroscopy

Our fertility specialists use hysteroscopy for the following indications:

• Diagnosing issues such as lesions in the uterus
• Abnormal endometrial thickening
• Abnormal uterine bleeding
• Postmenopausal bleeding
• Infertility
• Removal of fibroids, polyps or scar tissue within the uterus

The Procedure: How Hysteroscopy Before IVF Is Performed

Most hysteroscopies are performed in an examination room without general anesthesia (where the patient is put to sleep and requires a breathing tube). Doctors use moderate sedation (without a breathing tube) to help prevent discomfort.

However, if the healthcare provider needs to perform a hysteroscopy to remove fibroids or carry out other procedures on the cervix or uterus, it must be done in a surgical room under general anesthesia.

If the hysteroscopy is done in an exam room, no special preparation is needed. However, if your hysteroscopy is in an operating theatre under anesthesia, you should:

• Avoid eating or drinking after midnight the night before the surgery
• Avoid smoking for at least one day prior to your procedure
• Follow your doctor’s instructions regarding any medications and do not adjust doses on your own

After the procedure, your doctor will guide you on when to start IVF after hysteroscopy, which usually depends on whether any additional treatment was performed and your recovery.

Why Is Hysteroscopy Before IVF Recommended?

IVF is a costly procedure and results in a successful outcome in only about one-third of treatment cycles. Implantation failure can occur due to various factors, such as uterine receptivity or embryo quality, but in some cases the cause remains unknown. Hysteroscopy is considered the gold standard for evaluating the uterine cavity, providing a precise visual examination and allowing treatment of any pathology detected during the procedure.

Performing hysteroscopy before IVF can help detect structural uterine abnormalities that may be responsible for implantation failure, improving the chances of pregnancy. It can also reduce the financial and emotional burden of repeated IVF cycles by addressing issues that might be missed on other screening tests, such as hysterosalpingography.

This is particularly valuable for women with one or more prior failed IVF cycles, where correcting intrauterine abnormalities may enhance the likelihood of a successful outcome.

How Does Hysteroscopy Before IVF Improve IVF Success?

Intrauterine pathologies can influence conception rates in women undergoing IVF. Therefore, doctors often recommend evaluating the uterus before IVF procedures. Common methods for assessing uterine abnormalities include transvaginal sonography, hysterosalpingography and hysteroscopy.

However, hysterosalpingography may produce high false-negative and false-positive results. While transvaginal sonography is non-invasive and widely used, it may not detect all abnormalities. Hysteroscopy allows direct visual examination of the cervical canal and uterine cavity for adhesions, polyps, fibroids, inflammation or other abnormalities that could affect implantation.

It also enables the removal of polyps or fibroids, as well as performing an endometrial biopsy or curettage. Studies show that hysteroscopy can detect 30-45% of minor intrauterine abnormalities, which are commonly found in women with previous assisted reproductive technique failures.

Is Hysteroscopy Before IVF Painful?

The patient is given moderate sedation or anesthesia for hysteroscopy using intravenous medications. Mild cramping may be felt for a few hours after the procedure. Many women experience little discomfort and can resume their normal activities the next day.

If the hysteroscopy is performed in a surgical room under general anesthesia, recovery may take an additional two days.

Benefits of Hysteroscopy

Hysteroscopy allows doctors to diagnose and treat conditions in a single procedure. Additionally, it is minimally invasive and highly precise, enabling doctors to locate and remove abnormalities without damaging the surrounding tissues.

How safe is hysteroscopy?

Hysteroscopy is generally considered safe. However, like any surgical procedure, complications can occur. With hysteroscopy, complications occur in about 1% of cases and may include:

• Infection
• Intrauterine scarring
• Reaction to anesthesia
• Injury to the cervix, uterus, bowel or bladder
• Heavy bleeding

When Should You Talk to Your Doctor About Hysteroscopy Before IVF?

Contact your healthcare provider if you experience any of the following:

• Fever
• Heavy vaginal bleeding
• Severe abdominal pain

Conclusion

Hysteroscopy before IVF is important for examining and preparing the uterus for fertility treatment. This minimally invasive procedure allows direct visualisation of the uterine cavity and helps assess conditions such as polyps, fibroids, adhesions or structural abnormalities that may affect embryo implantation.

Detecting and treating these issues before IVF can create a more favourable environment for pregnancy and improve success rates. Often, hysteroscopy can diagnose and manage certain uterine conditions in the same procedure. Consulting a fertility specialist can help couples decide if hysteroscopy before IVF is appropriate for their fertility journey.