What Is Hysteroscopy? How Is It Performed and When Is It Used?

Intrauterine problems can play a significant role in menstrual irregularities, recurrent miscarriages, infertility, and IVF failures. While ultrasound is informative in many cases, some patients require direct visualization of the uterine cavity. Hysteroscopy is a modern diagnostic and therapeutic method that allows examination of the uterine cavity using a camera, without requiring abdominal incisions.

The question "What is hysteroscopy?" is frequently asked by patients with suspected uterine polyps, those advised to undergo uterine evaluation before IVF, women who have experienced recurrent miscarriages, or those who have been unable to achieve pregnancy despite good-quality embryo transfers.

With hysteroscopy, the inside of the uterus is visualized directly. Problems such as polyps, submucosal fibroids, adhesions, and uterine septum can be identified. In suitable patients, treatment can also be performed during the same session.

What Is Hysteroscopy?

Hysteroscopy is the visualization of the uterine cavity using a thin optical instrument equipped with a light and a camera. This instrument is advanced vaginally through the cervix and into the uterine cavity. No abdominal incision is made.

During the procedure, the interior of the uterus is displayed on a screen, allowing direct assessment of the endometrial lining, the uterine cavity, and any structural abnormalities that may be present.

Hysteroscopy is used not only for diagnostic purposes but also for the treatment of certain intrauterine problems. It therefore holds an important place in the evaluation of gynecological conditions, infertility, and IVF planning.

Why Is Hysteroscopy Performed?

Hysteroscopy can be performed for both diagnostic and therapeutic purposes.

The most common indications include:

1. Uterine polyps
2. Fibroids growing into the uterine cavity
3. Intrauterine adhesions
4. Congenital uterine anomalies such as uterine septum
5. Menstrual irregularities
6. Intermenstrual bleeding
7. Postmenopausal bleeding
8. Recurrent miscarriages
9. Recurrent IVF failures
10. Infertility investigations
11. Retained intrauterine devices or tissue fragments
12. Endometrial biopsy

Hysteroscopy provides valuable information, particularly in women planning a pregnancy, to determine whether the intrauterine environment is suitable for embryo implantation.

Who Should Have Hysteroscopy?

Hysteroscopy is not performed routinely for every patient. The decision is made by evaluating examination findings, ultrasound results, patient history, and pregnancy plans together.

Women with Abnormal Uterine Bleeding

Evaluation of the uterine cavity may be required in cases of heavy menstrual bleeding, intermenstrual bleeding, prolonged bleeding, or postmenopausal bleeding. Problems arising from polyps, fibroids, or the endometrium can be identified more clearly with hysteroscopy.

Patients Undergoing Infertility Investigation

For pregnancy to occur, the intrauterine environment must be suitable for embryo implantation. If there are polyps, adhesions, or structural irregularities inside the uterus, these can be detected by hysteroscopy.

Women with Recurrent Miscarriages

In patients who have experienced consecutive pregnancy losses, the uterine structure should be examined in detail. Problems such as uterine septum, adhesions, or polyps may increase the risk of miscarriage in some patients.

Patients with IVF Failure

If pregnancy does not occur despite the transfer of good-quality embryos, intrauterine factors may be investigated. In these patients, hysteroscopy may provide information that could change the plan for the next IVF attempt.

How Is Hysteroscopy Performed?

Hysteroscopy is generally a short procedure. The approach varies depending on whether it is diagnostic or operative.

The general steps of the procedure are as follows:

1. The patient is placed in a gynecological examination position.
2. The cervix is accessed vaginally.
3. A thin camera system called a hysteroscope is advanced into the uterine cavity.
4. The uterine cavity is expanded with a special fluid.
5. The interior of the uterus is examined in detail on the screen.
6. If necessary, procedures such as polyp removal, adhesion release, fibroid resection, or biopsy are performed.

Since the procedure is not performed through an abdominal incision, there is no visible scar. This makes the recovery process more comfortable for most patients.

The Difference Between Diagnostic and Operative Hysteroscopy

Diagnostic Hysteroscopy

The aim is to directly visualize the inside of the uterus and identify the source of the problem. In some cases, a small tissue sample may be taken.

Operative Hysteroscopy

In addition to diagnosis, treatment is also carried out. Uterine polyps, submucosal fibroids, adhesions, or uterine septum can be corrected during the same session in suitable patients.

When Is Operative Hysteroscopy Performed?

What is commonly referred to as "hysteroscopy surgery" is most often operative hysteroscopy.

The most frequent indications are:

1. Removal of uterine polyps
2. Resection of fibroids extending into the uterine cavity
3. Release of intrauterine adhesions
4. Correction of uterine septum
5. Removal of retained products of conception
6. Retrieval of an IUD that could not be removed in the office

Since these procedures are performed from within the uterine cavity, no abdominal incision is required.

Why Is Hysteroscopy Important Before IVF?

For an embryo to implant during IVF treatment, the intrauterine environment must be suitable. Even if the embryo is of good quality, the chance of implantation may be reduced if there are polyps, adhesions, fibroids, a septum, or chronic endometritis inside the uterus.

Pre-IVF hysteroscopy may be considered especially in the following patients:

1. Those with recurrent IVF failures
2. Those who have not achieved pregnancy despite good-quality embryo transfers
3. Those with suspicious intrauterine findings on ultrasound
4. Those with abnormalities on uterine imaging
5. Those who have previously undergone intrauterine surgery
6. Those with a history of recurrent miscarriage
7. Those with suspected uterine polyps or adhesions

Hysteroscopy is not necessary for every IVF patient. The correct decision should be made by evaluating the patient's history, ultrasound findings, and previous treatment outcomes together.

How Does Assoc. Dr. Nurettin Türktekin Approach This?

When deciding whether to perform hysteroscopy, looking only at the ultrasound finding is not sufficient. In Assoc. Dr. Nurettin Türktekin's clinical approach, the patient's complaints, pregnancy plans, history of miscarriage, IVF attempts, and intrauterine findings are all evaluated together.

The following questions are particularly important in patients planning IVF:

1. Was pregnancy achieved despite a previous high-quality embryo transfer?
2. Is there a suspicious finding on uterine imaging or ultrasound?
3. Does the endometrium reach adequate thickness during the transfer period?
4. Is there a possibility of polyps, fibroids, or adhesions inside the uterus?
5. Is there a history of curettage, uterine surgery, or infection?
6. Has the patient experienced recurrent miscarriages?

In some patients, hysteroscopy can directly change the treatment plan. In others, monitoring may be sufficient. For this reason, the procedure should be applied to the right patient at the right time.

Advantages of Hysteroscopy

1. The inside of the uterus is visualized directly.
2. No abdominal incision is required.
3. Diagnostic accuracy is high.
4. Treatment can be performed in the same session if needed.
5. Recovery time is short.
6. Most patients are discharged on the same day.
7. It can contribute to infertility treatment and IVF planning.
8. It can help avoid unnecessary major surgery.

Recovery After Hysteroscopy

Recovery after hysteroscopy is generally rapid. Most patients are discharged on the same day and can return to their daily lives within a short time.

Mild complaints that may be seen after the procedure:

1. Pelvic pain
2. Mild cramping
3. Light spotting
4. Mild fatigue

These symptoms usually subside within a few days.

Things to pay attention to after hysteroscopy:

1. Medications prescribed by the doctor should be taken regularly.
2. Heavy exercise should be avoided for a few days.
3. If bleeding increases, the doctor should be informed.
4. Foul-smelling discharge, fever, or severe pain should not be ignored.
5. Sexual intercourse should be avoided until the doctor advises otherwise.

Recovery time may vary depending on whether the procedure was diagnostic or operative.

Is Hysteroscopy a Risky Procedure?

Hysteroscopy is considered a safe procedure when performed by an experienced physician. Nevertheless, as with any medical intervention, rare risks exist.

Possible risks include:

1. Infection
2. Bleeding
3. Injury to the uterine wall
4. Complications related to the distension fluid
5. Anesthesia-related side effects

These risks are uncommon. Proper patient evaluation before the procedure, appropriate technique, and an experienced team enhance safety.

When Can Pregnancy Be Planned After Hysteroscopy?

The timing of pregnancy planning depends on the procedure performed. If only diagnostic hysteroscopy was performed, pregnancy can often be planned within a short time. If treatment was carried out for polyps, fibroids, adhesions, or uterine septum, some time may need to pass to allow the uterus to heal.

In patients planning IVF, the timing of embryo transfer is determined based on the healing status of the uterine cavity and the scope of the procedure performed.

Is Hysteroscopy Necessary for Every Patient?

No. Hysteroscopy is a valuable method, but routine application in every patient is not required.

It becomes more meaningful in the following situations:

1. Suspicious intrauterine finding on ultrasound
2. Abnormality detected on uterine imaging
3. History of recurrent miscarriage
4. History of recurrent IVF failure
5. Suspected polyp, fibroid, or adhesion
6. Postmenopausal bleeding
7. Unexplained abnormal bleeding

Correct patient selection maximizes the benefit of the procedure.

When Should You See a Gynecologist?

Specialist evaluation should be sought in the following situations:

1. If your periods are very heavy or irregular
2. If you experience intermenstrual bleeding
3. If you have had postmenopausal bleeding
4. If you have a history of recurrent miscarriage
5. If you are having difficulty achieving pregnancy
6. If your IVF attempts have been unsuccessful
7. If a uterine polyp or fibroid has been suspected on ultrasound
8. If an abnormality has been detected on uterine imaging
9. If you have previously undergone intrauterine surgery

Assoc. Dr. Nurettin Türktekin's Perspective

Hysteroscopy is one of the most valuable methods for directly visualizing the inside of the uterus. In patients with infertility, recurrent pregnancy losses, and failed IVF attempts in particular, a detailed examination of the intrauterine environment can change the treatment plan.

What is important in clinical evaluation is that hysteroscopy should not be applied routinely to every patient, but to the right patient at the right time. In suitable patients, the hysteroscopic treatment of polyps, adhesions, submucosal fibroids, or uterine anomalies may support the chances of pregnancy.

Uterine evaluation is as important a step in IVF planning as embryo quality, because the intrauterine environment must also be suitable for a healthy embryo to implant.

Conclusion

Hysteroscopy is a method used in the diagnosis and treatment of intrauterine problems that does not require abdominal incisions, provides rapid recovery, and offers high diagnostic accuracy.

It can provide important information in cases of uterine polyps, submucosal fibroids, intrauterine adhesions, uterine septum, recurrent miscarriages, menstrual irregularities, and IVF failures.

A gynecologist should be consulted, particularly when there are menstrual irregularities, postmenopausal bleeding, recurrent pregnancy loss, infertility, IVF failure, or suspicious intrauterine findings on ultrasound.

Hysteroscopy performed in the right patient can both clarify the diagnosis and make a significant contribution to the treatment process.

Frequently Asked Questions

Is hysteroscopy a painful procedure?

Diagnostic hysteroscopy may cause mild cramping in some patients. Sedation or anesthesia may be preferred for operative procedures.

How long does hysteroscopy take?

Diagnostic hysteroscopy is generally brief. While the duration of operative hysteroscopy varies depending on the procedure, many procedures can be completed within 10–30 minutes.

Is hospitalization required after hysteroscopy?

Most patients are discharged on the same day. The observation period may be longer for more extensive operative procedures.

Is there bleeding after hysteroscopy?

Yes. Light spotting may be seen. Heavy bleeding, foul-smelling discharge, or fever should prompt a visit to the doctor.

Does hysteroscopy improve the chance of pregnancy?

If there are intrauterine problems such as polyps, adhesions, fibroids, or a septum that are preventing embryo implantation, treating these issues may support the chance of pregnancy in some patients.

Can fibroids be removed by hysteroscopy?

Some fibroids with suitable locations that are growing toward the uterine cavity can be removed by hysteroscopy. Different surgical methods may be required for fibroids extending outside the uterine wall or into its deeper layers.

When can you return to work after hysteroscopy?

Many patients can return to work the day after diagnostic hysteroscopy. Recovery time for operative procedures varies depending on the intervention performed.

When can sexual intercourse resume after hysteroscopy?

It is generally recommended to avoid sexual intercourse for a few days. The duration should be determined by the doctor based on the procedure performed and the patient's recovery.

Is hysteroscopy always necessary before IVF?

No. It is not mandatory for every patient. It may be recommended in cases of recurrent failure, suspicious intrauterine findings, history of miscarriage, or suspected polyps or adhesions.

When can IVF be performed after hysteroscopy?

This depends on the procedure performed. Planning can be made sooner after diagnostic hysteroscopy, while waiting for the uterus to heal is necessary after operative procedures.