Hysteroscopy for IVF (A Helpful Guide On When Should You Do It & Why)

Do you need to get a hysteroscopy for your IVF cycle?

In this article, you will learn:

  • Why a hysteroscopy is done before IVF,
  • If hysteroscopy will increase your IVF success,
  • What to expect during the procedure,
  • and more

Let’s get started.

hysteroscopy for ivf cover image

Disclaimer:

Although I am a physician by profession, I am not YOUR physician. All content and information on this website are for informational and educational purposes only.  It does not constitute medical advice and does not establish any kind of doctor-client relationship by your use of this website. Although I strive to provide accurate general information, the information presented here is not intended for the prevention or treatment of disease and it is not a substitute for medical or professional advice. You should not rely solely on this information. Always consult your physician in the area for your particular needs and circumstances prior to making any decisions whatsoever. Those who do not seek counsel from the appropriate health care authority assume the liability of any damage, loss, or injury which may occur.


What is a hysteroscopy?

A hysteroscopy is a gynecologic procedure used to examine the inside of your uterus.

The procedure involves inserting a thin telescope/camera (the hysteroscope) through the vagina and cervix and into the uterus. The hysteroscope allows the doctor to identify and potentially treat any problems that could interfere with embryo implantation.

Why is hysteroscopy done before IVF?

Hysteroscopy is done before IVF to ensure that you have a normal-appearing uterine cavity before embryo implantation.

Common reasons why your doctor might recommend a hysteroscopy before you start an IVF cycle include:

  • To identify and remove endometrial polyps or fibroids that could interfere with embryo implantation.
  • To determine if there are any uterine adhesions or scar tissue from a prior uterine procedure.
  • To look for any uterine abnormalities like a uterine septum.
  • To rule out a structural cause of recurrent miscarriages or recurrent implantation failure.

Is hysteroscopy needed or required for IVF?

A routine hysteroscopy isn’t always necessary for IVF. Other less expensive methods such as a hysterosalpingogram (HSG) and saline infusion sonography (SIS) can be used to evaluate the inside of your uterus before doing an embryo transfer.

However, hysteroscopy is the best way to identify and potentially treat any issues present in the cavity.

An HSG and SIS are screening tests. If we suspect an abnormality on these two tests, we will recommend a confirmatory hysteroscopy.

When should a hysteroscopy be done before IVF?

A hysteroscopy should be done before IVF if you plan on having a fresh embryo transfer and there is a concern about an abnormality inside your uterus.

However, if you are having a frozen embryo transfer (FET), a hysteroscopy does not need to happen before undergoing IVF.

You can undergo ovarian stimulation, trigger, egg retrieval, IVF, and freeze your embryos before a hysteroscopy.

A uterine cavity evaluation should be done before the embryo transfer, not necessarily before IVF.

When is the best time to have a hysteroscopy?

If you are planning a fresh embryo transfer, the best time to have a hysteroscopy is just before your IVF cycle. Doing so will ensure that any potential problems are identified and treated before undergoing ovarian stimulation and oocyte retrieval.

However, if you are freezing your embryos, the best time to have a hysteroscopy is within 2-6 months of the anticipated transfer date.

Does having a hysteroscopy increase fertility or IVF success?

A diagnostic hysteroscopy by itself does not improve fertility or IVF success rates. However, if an intrauterine abnormality is identified and treated (polypscar tissue, uterine fibroids), hysteroscopy may improve IVF live birth rates.

How long after a hysteroscopy can you do an embryo transfer?

A few studies demonstrate that you should perform an embryo transfer within 180 days following a hysteroscopy (study 1) (study 2) (study 3).

Can you do a hysteroscopy and IVF in the same cycle?

Studies indicate that you can do an embryo transfer in the same cycle or as early as the next menstrual cycle following a hysteroscopy without impacting pregnancy rates.

In terms of an IVF cycle, it is possible to do hysteroscopy and IVF in the same cycle if you are using birth control pills to regulate your hormones and your uterine lining.

What to expect during a hysteroscopy

Now let’s discuss what you can expect before, during, and after the procedure.

The day before the procedure

Your doctor will instruct you to stop eating or drinking after midnight on the day before your procedure.

You may take your regular medications with a small sip of water.

Also, you will need to make sure that you have someone who can escort you home after the procedure.

During the procedure

A hysteroscopy is a minimally invasive procedure performed in the office setting or at an ambulatory center.

You will be under anesthesia during the procedure so that you won’t feel any pain.

Once you are asleep, the doctor will insert a speculum into your vagina and dilate your cervix just enough to allow the hysteroscope to enter the uterus.

The hysteroscope distends the uterus by introducing water into the uterine cavity. If a polyp or scar tissue is present, we can remove it during the same procedure. More extensive abnormalities such as large submucous fibroids may require a second procedure.

The procedure can take as little as 15 minutes if the hysteroscopy goes smoothly, but bigger abnormalities can take an hour or more.

Recovery from a hysteroscopy

In most cases, you will be able to go home the same day as your office hysteroscopy. Recovery is usually is relatively quick, with most women feeling back to normal within a day or two.

However, you may experience cramping and bloating for a day or two after the procedure. It is also not uncommon to have light bleeding for a few days following the hysteroscopy.

Heavy bleeding is unusual and might require an evaluation.

Other Related Questions

What day of my cycle is hysteroscopy done?

The optimal timing for hysteroscopy is on days 5-9 of your menstrual cycle as you are likely to have stopped bleeding, and the lining of the uterus is thin.

Can a hysteroscopy be done while on your period?

It is not ideal to have a hysteroscopy when you are on your period, as the blood can obscure the view of the uterine cavity.

Do you typically do a hysteroscopy after failed IVF?

If you have had a failed IVF/ embryo transfer cycle, your doctor may recommend a hysteroscopy to evaluate the uterine cavity for a potential cause.

Unfortunately, a hysteroscopy does not always reveal the underlying cause of a failed implantation or a spontaneous miscarriage. However, if an abnormality is found and treated, it may improve the chances of success with future IVF cycles.

When do you do a hysteroscopy after egg retrieval?

You can do the hysteroscopy after egg retrieval if you plan on doing a Frozen Embryo Transfer (FET) in the future. Freezing the embryos provides flexibility in the timing of events.

Can hysteroscopy be done during egg retrieval?

There are studies showing that hysteroscopy can be done during the egg retrieval without any adverse effects. However, fertility clinics do not routinely use this approach as each procedure requires time, trained personnel, specific equipment, and other logistics.

Do I need general anesthesia?

In most cases, hysteroscopic surgery is done under IV sedation, not general anesthesia.

What are the risks?

Outpatient hysteroscopy is a relatively straightforward and safe procedure. The most common complications include bleeding, infection, fluid overload, and a small risk of poking a hold in the uterus.

Thankfully, these risks are minimal (less than 0.5%).

Final Words

Diagnostic hysteroscopy is a valuable tool that can help assess the uterine cavity for abnormalities that may interfere with fertility or IVF outcomes.

Although other imaging studies can be used for the evaluation of the uterine cavity, hysteroscopy remains the gold standard and an important part of the diagnostic infertility workup.


alex robles md

Alex Robles, MD

Alex Robles is a Spanish-speaking Latino-American Reproductive Endocrinologist and Infertility specialist in New York City, and board-certified OBGYN in his final year of fellowship at Columbia University Medical College. He has a special interest in exercise, lifestyle, & nutrition.


References:

  1. Bingol, B., Gunenc, Z., Gedikbasi, A., Guner, H., Tasdemir, S., & Tiras, B. (2011). Comparison of diagnostic accuracy of saline infusion sonohysterography, transvaginal sonography and hysteroscopy. Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology31(1), 54–58. https://doi.org/10.3109/01443615.2010.532246
  2. Eserol F, Göksever Çelik H, Aytan AN, et al. The effect of diagnostic hysteroscopy performed before fresh and frozen-thawed embryo transfer in IVF cycles on reproductive outcomes. J Turk Ger Gynecol Assoc. 2021;22(3):206-211. doi:10.4274/jtgga.galenos.2021.2020.0136
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  5. Deng, Ke1,2; Song, Xiao-Hua1,2,3; Han, Xue-Mei4; Kong, Wei-Ya1,2; Liu, Wei1,2; Han, Ting2; Yan, Lei1,2 Optimal waiting period for fresh embryo transfer after hysteroscopic adhesiolysis, Chinese Medical Journal: October 5, 2019 – Volume 132 – Issue 19 – p 2333-2339
  6. Tu, Y. A., Yang, P. K., Chen, S. U., & Yang, J. H. (2020). Optimal time interval between hysteroscopic polypectomy and frozen-thawed blastocyst transfer: A retrospective study. PloS one15(10), e0240882.
  7. Aharon, D., Sekhon, L., Lee, J. A., Ascher-Walsh, C., & Copperman, A. B. (2019). Optimal Interval of Time from Operative Hysteroscopy to Embryo Transfer in an In Vitro Fertilization Cycle. Journal of minimally invasive gynecology26(6), 1083–1087.e1. https://doi.org/10.1016/j.jmig.2018.10.019
  8. Zhu X, Ye H, Fu Y. The effect of frozen-thawed embryo transfer performed concurrently with hysteroscopy on the reproductive outcomes during assisted reproductive treatments. Sci Rep. 2017;7(1):11852. Published 2017 Sep 19. doi:10.1038/s41598-017-12068-1
  9. Jansen, F. W., Vredevoogd, C. B., van Ulzen, K., Hermans, J., Trimbos, J. B., & Trimbos-Kemper, T. C. (2000). Complications of hysteroscopy: a prospective, multicenter study. Obstetrics and gynecology96(2), 266–270. https://doi.org/10.1016/s0029-7844(00)00865-6
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