Hysteroscopy

A doctor may recommend hysteroscopy procedure as a part of your cost-effective infertility workup, because the cervix, the endocervical canal, the uterine cavity and the fallopian tubes should be evaluated to look for any possible cause of infertility. Also, if a woman has heavy menstrual periods with severe cramping, then even Hysteroscopy might be suggested. It is a procedure that allows the doctor to look inside the uterus to diagnose and treat the causes that lead to abnormal bleeding.

What is hysteroscopy?

Hysteroscopy means a surgery done using a hysteroscope, which is a thin, lighted tube that is inserted inside the vagina to check the cervix and inside of the uterus. The procedure helps to get a closer look at the cervix and uterus and diagnose the cause of the problem. If the doctor finds something abnormal, then she can take out a sample during the procedure and test it later.

When is hysteroscopy suggested?

Hysteroscopy procedure is suggested when a woman has abnormal periods, i.e. either her periods are too heavy, or the length of her cycle is too long that means if she is bleeding more frequently, or bleeding less regularly and if she bleeds in between her periods. So, the indication of doing hysteroscopy can be summarised as:

  • If a woman is having abnormal Periods.
  • Bleeding after Menopause.
  • To diagnose the presence of fibroids, polyps or scar tissues.
  • It can also help to determine any kind of uterine malformation.
  • Recurrent miscarriages.
  • If a biopsy is suggested.
  • As a part of an Infertility workup.
  • To locate the position of an Intrauterine Device (IUD).
  • In case of abnormal Pap smear test.
  • To perform sterilisation as a part of birth control.

How is hysteroscopy procedure done?

During the procedure, a vaginal speculum is used to dilate the cervix. Then a hysteroscope is inserted into the cervix to reach the lower end of the uterus. Depending on how complicated a procedure is, a hysteroscopy can either be performed under local anaesthesia or general anaesthesia.

Then either carbon dioxide gas or saline solution is passed through the hysteroscope into the uterus to expand it. This allows the doctor to get a clear view of the uterine structure. It becomes easier to examine each part minutely, such as the lining of the cervix, the endometrial lining and the opening of the fallopian tubes.

During the procedure, if any abnormality is found, then the doctor may do a curettage (it is a medical procedure which is done to remove tissues by either scraping it or scooping it) after hysteroscopy. The endometrial tissue may be sent to the laboratory to check for any pathological findings.

Types of Hysteroscopy

Hysteroscopy can be either diagnostic or operative.

Diagnostic Hysteroscopy

As the name suggests, it is done to diagnose uterine problems. To confirm the diagnosis of the problem, diagnostic hysteroscopy is recommended after an HSG (hysterosalpingography) test. The procedure takes approximately 30 minutes to perform and is usually done on a day-care basis. This procedure can help identify abnormalities in the uterine cavity like:

  • Uterine Fibroids
  • Uterine Polyps
  • Uterine adhesions
  • Any malignant mass

Operative Hysteroscopy

As the name suggest is done to treat the abnormalities that were found during diagnostic hysteroscopy. If any abnormalities are found, then an operative hysteroscopy can be performed simultaneously along with diagnostic hysteroscopy hence avoiding a second surgery. During this procedure, surgical instruments like scissors, forceps and graspers are needed to remove any uterine growth or adhesions like:

Hysteroscopy with Myomectomy

Hysteroscopic myomectomy is done for the complete removal of the fibroid without causing damage to the normal uterine tissue. It is the best option for women who want to have children after the procedure, or for them who want to keep their uterus intact.

Hysteroscopy with Polypectomy

Polyps found inside the uterus (endometrial polyps) can cause heavy menstrual bleeding, irregular bleeding, or abnormal bleeding after menopause. In this case, Hysteroscopic Polypectomy may be suggested to remove uterine polyps.

Hysteroscopy with Uterine Adhesiolysis

While undergoing an intrauterine procedure, such as D&C, myomectomy, or a miscarriage, many women may develop scar tissue which can partially or entirely destruct the uterine cavity. The condition is known as Asherman’s Syndrome. In these cases, Hysteroscopic adhesiolysis is suggested, which involves the removal of adhesions in the uterus.

Hysteroscopic Metroplasty

Congenital abnormality like uterine septum is a common reason for recurrent miscarriages. This abnormality can be treated by safely cutting it through a hysteroscope so that it can come back to a normal shape. After the procedure, patients are kept on hormone therapy for a period of 1 or 2 months that helps in rebuilding the uterine cavity.

Hysteroscopic Endometrial Ablation

Women who are facing irregular vaginal bleeding, and for whom medicines have failed to bring any relief, they may be suggested with endometrial ablation keeping in mind their reproductive status, that is if they are done with childbearing. In this procedure, the hysteroscope utilises energy or hot water to resect or destroy the endometrium. After the procedure, about 40% of women will have lighter menses, another 40% of them will have complete cessation of their menses, and 20% of them would have no change in their symptoms.

Hysteroscopy with D&C

To evaluate the causes of abnormal uterine bleeding and to rule out malignancy in post-menopausal patients Hysteroscopy with D&C (Dilation and Curettage) is performed. It involves the dilation of the cervix and scraping of the uterine lining, and it is done under anaesthesia in the operating room.

Hysteroscopic Sterilisation

For women who want permanent sterilisation, for them, hysteroscopic tubal occlusion can be done. That is the opening of the fallopian tubes within the uterine cavity can be placed with small occlusion devices. Within three months, tissues grow in this occlusion devices and permanently obstructs the fallopian tube thus causing sterilisation. To confirm whether the procedure was successful or not, a Hysterosalpingogram could be performed after three months.

Hysteroscopic Tubal Cannulation

Women with a mild tubal blockage can opt for hysteroscopic tubal cannulation. With the help of hysteroscopy, the opening of the fallopian tubes is visible within the uterine cavity. A small catheter is placed through the opening of the fallopian tube to establish a tubal patency. To confirm tubal patency a laparoscopy or a post-operative hysterosalpingogram can be done.

Hysteroscopy Side Effects

Any medical procedure will have some risk associated with it. The complications that can arise after a hysteroscopy procedure are:

  • You may have a problem with the anaesthesia given.
  • Though very rare, there may be tearing or damage to your cervix.
  • You may contract an infection of the uterus or fallopian tubes after the procedure.
  • Bleeding may occur, and there might be a uterine perforation.
  • You may face a problem with the carbon dioxide gas or saline solution that was inserted. Excessive fluid absorption by the body may cause nausea and vomiting.
  • The hysteroscope could damage the nearby organs like the ovaries, bladder or bowels.
  • You could develop a Pelvic Inflammatory Disease.

Hysteroscopy Recovery

Patients who have undergone hysteroscopy complain of mild nausea, dizziness and uterine cramping, which can be managed well with pain medications. Some patients may have light spotting for a day or two. If carbon dioxide gas was used, then one can have shoulder pain. Patients can go home the same day after the procedure if local anaesthesia was given and resume regular activity within 48 hours. In the case of general anaesthesia, and if there is a history of reaction to anaesthesia, then a doctor may keep you under observation for a day.

Doctors usually suggest avoiding sexual intercourse after the procedure for a minimum of two weeks so that they don’t develop an infection. And if the patient experiences heavy vaginal bleeding, foul discharge, continuous pain or develops fever, she should immediately inform her Doctor.

Hysteroscopy for Infertility

Hysteroscopy is considered to be a valuable diagnostic and operative procedure in the management of infertility. With the help of a hysteroscope, the entire uterine cavity can be inspected in a matter of minutes. The endometrial and tubal causes of infertility have been sought with the help of hysterosalpingography, laparoscopy, endometrial biopsy etc. Hysteroscopy is used as an adjunct to these methods, to increase their effectiveness in evaluating uterine or tubal factors, that may account directly or indirectly for reproductive failures. Several studies also suggest that hysteroscopy has helped enhance fertility rates in many infertile women.

Hysteroscopy Cost

Hysteroscopy surgery cost will depend on the procedure, whether it is diagnostic or operative. A diagnostic hysteroscopy test cost is much less than an operative hysteroscopy. The cost will be higher depending on the extent of the procedure, whether it involves the removal of fibroids, polyps so on, also if you are having the procedure in a hospital. And to add on the hysteroscopy cost in Delhi, Hyderabad or other places will also depend on the type of anaesthesia used, whether general or local.

To know the exact hysteroscopy cost in Hyderabad or other places, you can call us at +917862800700 or mail us at contact@medicoverfertility.in. Our financial counsellor will guide you with the hysteroscopy procedure cost by looking at your medical history.

Difference between Hysteroscopy & Laparoscopy

The difference between Diagnostic laparoscopy and diagnostic hysteroscopy are: A diagnostic laparoscopy may be recommended to look at the outside of the uterus, fallopian tubes, ovaries, and internal pelvic area, whereas Diagnostic hysteroscopy is a procedure recommended to view inside the uterine cavity.

 

FAQs

Q – Is hysteroscopy painful?

A – The procedure shouldn't be painful, as it is performed under local or general anaesthesia depending on the extent of the procedure. A woman may, however, experience mild cramping during the procedure.

Q – Can a hysteroscopic procedure detect cancer?

A – A doctor generally recommends hysteroscopy if any abnormality is found during the ultrasound. It helps the doctor to visualise the internal structure of the uterus, and during the procedure, if they see something abnormal, then he/she can remove the tissue and send for examination (biopsy). So yes, a hysteroscopic procedure can help to detect cancer, and if uterine cancer is diagnosed early, then it can be treated successfully.

Q – Do you bleed after a hysteroscopy?

A – Bleeding and cramping may be a side-effect that may arise after a hysteroscopy procedure. But it will go in a day or two.

Q – Is hysteroscopy necessary before IVF?

A – Uterine problems are major contributing factors leading to infertility and miscarriage. So, to detect any abnormality in the uterine cavity, hysteroscopy is considered as the gold standard. Infertility clinics can perform a hysteroscopy to evaluate the uterus for the presence of uterine growths or scar tissue and remove them before opting for IVF cycle, to increase the success rate.

Q – How much does hysteroscopy cost?

A – The laparoscopy hysteroscopy cost in India depends upon the procedure, whether it is diagnostic or operative. It varies from person to person.

 

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4165957/

https://www.sciencedirect.com/science/article/pii/S0029784400008656

https://www.sciencedirect.com/science/article/pii/S0002937896706804

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5724875/

https://europepmc.org/article/med/6193274

https://www.sciencedirect.com/science/article/abs/pii/S0889854505700632

https://journals.lww.com/clinicalobgyn/citation/1992/06000/operative_hysteroscopy_for_infertility.4.aspx