About 10% of women
and 1 in 8 couples
have trouble getting or staying pregnant. If you struggle with infertility, you may feel overwhelmed, alternating between feelings of despondency and hope, frustration and excitement, all centered around the potential to become a parent. Infertility is a whirlwind of emotions, and it can often involve a wide range of medical procedures and tests.
Infertility initiates you into a strange new world you never wanted to be a part of. There are many terms to know and learn, physical mechanics of the reproductive system you might not have fully been aware of or understood, and an endless array of test, medications, and procedures. If your doctor has recommended a hysteroscopy, you might wonder if it’s a good choice for you.
Or if you've been reading about infertility online and tallying your symptoms, you might have concluded that a hysteroscopy could be a good starting point for treating your fertility issues. Here’s everything you need to know about this procedure.
A hysteroscopy procedure can diagnose, and in some cases treat, a wide range of problems with the uterus. The term hysteroscope means “uterus tube,” and indeed that’s exactly what’s used during the procedure. During a hysteroscopy, a doctor inserts a thin, flexible tube called a catheter into the uterus. The provider accesses the uterus through the cervix by way of the vagina.
In most cases
, a hysteroscopy is used to examine the uterus to diagnose causes of abnormal bleeding. For example, if a woman has heavy bleeding between periods, a doctor might recommend hysteroscopy.
A doctor might also recommend a hysteroscopy for any of the following symptoms:
- Two or more miscarriages
- An IUD that has dislodged
- To get a sample of uterine tissue for a biopsy
- Signs of blocked fallopian tubes or pelvic inflammatory disease
- A history of STIs that affect the uterus
- Abnormal Pap test
- Fibroids, polyps, or scarring on the uterus
- A recent or suspected injury to the uterus
Hysteroscopy is an outpatient procedure, which means your doctor can do it in their office or in a surgical center. You do not have to be under anesthesia, though some women choose to be under general anesthesia. Your recovery time will be short, and you can go home the same day. The procedure is very safe, and some doctors use it as an alternative to more invasive procedures.
In addition to diagnosing common uterine conditions, hysteroscopy can also treat some conditions. If your doctor discovers an issue with your uterus, she may also be able to treat that issue during the same procedure.
It is not safe to perform a hysteroscopy on a woman who is pregnant so you will need to take a pregnancy test before undergoing the procedure. In some cases, a doctor may also require the woman to use contraceptives or avoid intercourse prior to hysteroscopy. Most doctors will not perform a hysteroscopy on a woman who is getting her period because this makes it harder to see the uterus. So a woman may need to track her cycles to choose the best day to schedule the procedure.
Can a Hysteroscopy Treat Infertility?
Issues with the uterus can affect fertility in a few ways. For a woman to get pregnant, she must ovulate a healthy egg, ideally every month since more frequent ovulation means more frequent opportunities to conceive. Her partner must have healthy sperm that can swim to the egg, and the couple must time intercourse to optimize the chances of fertilization. Ovulation issues and other egg-related concerns are the leading cause of infertility in women. Uterine issues, however, account for about 10% of infertility cases.
After an egg is fertilized, it must implant into the lining of the uterus. This process, known as implantation, takes about a week following the fertilization of the egg. It also marks the medical beginning of pregnancy.
Growths in the uterus, abnormal uterine tissue, abnormal uterine bleeding, and similar issues can block implantation. In some cases, issues with the uterus may also trigger an early miscarriage called a chemical pregnancy. In a chemical pregnancy
, a woman might not even realize she is pregnant. Or she might have a positive pregnancy test followed a few days later by a negative one.
Sometimes issues in the uterus affect other organs. Women with endometriosis have a condition that causes endometrial tissue -- the tissue that lines the uterus -- to travel outside of the uterus. This can damage the ovaries and fallopian tubes. It may even prevent ovulation, or make it more difficult for a sperm to fertilize an egg.
Hysteroscopy can diagnose a wide range of issues with the uterus. Hysteroscopy may also treat some uterine issues. If a doctor detects abnormal tissue, a polyp, fibroid, or other growth, the doctor may be able to remove these growths during the hysteroscopy.
If your doctor suspects there may be an issue with your fallopian tubes, she may perform a related procedure, called hysterosalpingography
. This procedure allows a doctor to look at both the uterus and fallopian tubes and can help clear blocked tubes. Pelvic infections, pelvic inflammatory disease, and endometrial tissue may congest the fallopian tubes.
Hysteroscopy Procedure: Is it Painful?
It’s natural to worry about pain during any medical procedure. Many women also feel anxious about feeling “exposed,” since a doctor accesses the uterus through the vagina. Your doctor will give you a sheet to cover your lower body to help you feel less exposed, and you will only be naked below the waist for a few minutes. As with any medical procedure, you can ask the doctor to stop if you feel uncomfortable at any point.
A hysteroscopy can be done in two ways:
- Some women choose local anesthesia. With local anesthesia, a doctor injects a numbing agent into the uterus. The woman may also be sedated using an IV sedative. You might feel some pressure or a pinch during the numbing injection in the cervix, and the insertion of the IV feels a lot like getting a vaccination or having blood drawn. You may feel pressure or unusual sensations in your stomach or pelvis. Some women report sensations similar to menstrual cramps, while others feel nothing at all. If you experience intense pain, pinching, or discomfort that feels unbearable, tell your doctor.
- Other women choose general anesthesia. With general anesthesia, you will be completely asleep and unaware. You will not feel anything. You will likely receive an IV before being put under, and this can pinch. Otherwise, you will be unconscious during the procedure and have no recollection of the process.
After the procedure, you should feel fine. Some women notice some cramping or spotting. A few feel queasy following the anesthesia or sedative. In almost all cases, you’ll need someone to drive you home, but you should be able to return to your normal activities fairly quickly.
How Does a Doctor Perform a Hysteroscopy?
The procedure for hysteroscopy is as follows:
- A doctor will take a complete medical history.
- The woman undergoes anesthesia or sedation according to her preference and her doctor’s advice.
- The woman lies on her back, naked from the waist down, usually with her feet in stirrups.
- A doctor inserts a speculum into the vagina to better see the vaginal walls and cervix.
- The doctor dilates the cervix to open it slightly. This can cause some cramping similar to menstrual cramps.
- The doctor inserts the hysteroscope into the vagina, through the cervix, and into the uterus.
- The doctor adds carbon dioxide or a liquid gas to the hysteroscope. This helps open the cervix and remove secretions so the doctor can better see the uterus.
- A doctor will use a light to see the inside of the uterus. If there is a blockage that can be cleared through the hysteroscope, a doctor may insert instruments to clear that blockage.
After the procedure, your doctor will discuss the results with you. Together you will weigh other treatment options and future plans.
Who Should Consider a Hysteroscopy?
A hysteroscope is a safe but invasive procedure. Because ovarian issues are a leading cause of female infertility, your doctor will want to rule these out first, usually with blood work to assess whether you are ovulating. You may also need to monitor your cycles and look for signs of regular ovulation.
It’s also important to test the man for signs of infertility. About a third of infertility cases are due to the man, and another third are due to issues with both partners. So failing to test the man can miss a wide range of infertility issues, and lead to needless diagnostic procedures and treatments in the woman.
After initial testing, a doctor may suspect the problem is with the uterus. Some indications that a hysteroscopy may help include:
- History of STDs that might cause pelvic inflammatory disease.
- Unexplained uterine bleeding, especially if the bleeding is heavy.
- A history of endometriosis.
- Regular ovulation but no pregnancy after 12 months of trying.
- A history of two or more miscarriages in a row.
- Having several chemical pregnancies.
- Uterine pain or pressure.
- Intense menstrual cramps or pain during sex.
- Passing large blood clots during menstruation.
A doctor may also recommend a hysteroscopy before IVF, or after a failed IVF procedure since IVF failure is often due to issues with the woman’s uterus.
Other Infertility Treatments
Hysteroscopy is just one of many infertility treatments. Infertile couples may feel hopeless and overwhelmed or worry that treatment will be expensive or ineffective. But with expert care, most couples can become parents. The right treatment depends on getting an accurate diagnosis, and on testing both partners.
Some common fertility issues include:
- Ovulation problems, which can often be easily treated with ovulation induction.
- Health problems such as chronic illnesses.
- Issues with the man’s sperm, which may be treated with IUI, IVF, or donor sperm.
- A depleted ovarian reserve in the woman. Sometimes ovarian induction helps, but in other cases, it may be necessary to use donor eggs.
- Unexplained infertility. If a doctor cannot diagnose the cause of infertility, she may recommend IVF, ovulation induction, lifestyle changes, or other treatments.
Infertility is treatable, and the sooner you seek care the greater are your odds of success. Fertility declines with age, and declines precipitously once you're in your late 30s and 40s, so it’s important to see a provider as soon as you realize there is an issue.
When to See a Fertility Specialist
We recommend seeing a fertility specialist if
Some couples also opt to undergo
- You have had two or more miscarriages in a row.
- The woman is over 35 and you have tried for 6 months or longer to get pregnant.
- The woman is under 35 and you have tried for a year or longer to get pregnant.
- The man is over 40 and you have tried for 6 months or longer to get pregnant.
- Either partner has a prior history of infertility.
- The woman has irregular menstrual periods, very heavy periods, or periods that are very far apart.
- Either couple has been diagnosed with a condition that can affect fertility, such as diabetes, polycystic ovary syndrome (PCOS), or endometriosis.
testing before trying for a baby. This can offer significant peace of mind and help you avoid wasting time.
Trying to get pregnant can be difficult, and even heartbreaking. The drive to become a parent is strong, and couples who struggle with infertility may feel isolated and overwhelmed. Many couples struggle with marital issues or feel stigmatized and shamed by family. Rest assured, you are not alone. Expert help can demystify infertility, reassure you that it’s not your fault, and help you become a parent as quickly as possible.
The Center of Reproductive Medicine would love to partner with you as you walk this difficult path. We can connect you to a wide range of resources, and draw on our years of expertise to maximize your chances of pregnancy. If you’re ready to end the heartache and try a more productive course of action, we’re ready to help. Give us a call today!
March 22, 2021