When Fertility Problems Point to Your Uterus: What a Hysteroscopy Can Reveal

A hysteroscopy is a minimally invasive examination that allows doctors to see directly inside your uterus to diagnose and treat fertility problems, repeated miscarriages, and other reproductive concerns. Unlike ultrasounds or other imaging tests, this procedure gives your doctor a clear, real-time view of what's happening in your womb, making it one of the most effective tools for understanding why conception or pregnancy may be difficult.

Why Would Your Doctor Recommend a Hysteroscopy?

If you've been trying to get pregnant without success or have experienced multiple miscarriages, your gynecologist might suggest a hysteroscopy to investigate the underlying cause. The procedure can reveal structural problems or other issues that standard tests might miss. "If you're experiencing heavy or irregular periods, bleeding between periods or after menopause, fertility concerns or recurrent miscarriage, then a hysteroscopy may be recommended," explains Miss Madhu Ghosh, a consultant gynaecologist at London Gynaecology.

Beyond fertility issues, doctors use hysteroscopy to diagnose and treat several conditions that can affect your ability to conceive or carry a pregnancy to term:

• Uterine Polyps: Small growths on the uterine lining that can interfere with implantation or increase miscarriage risk
• Fibroids: Benign tumors in the uterus that may distort the cavity and affect fertility
• Endometrial Cancer: Abnormal cell growth that requires early detection and treatment
• Missing IUD Threads: If your intrauterine device (IUD) contraceptive coil's thread has disappeared, hysteroscopy can locate and remove it

What Actually Happens During the Procedure?

The good news: there are no cuts or incisions involved. A hysteroscopy is performed using a fine telescope called a hysteroscope, which is inserted through your vagina and cervix into your uterus. "A fine telescope called a hysteroscope, is inserted via your vagina and opening of your uterus. Using saline, the telescope passes through your cervix and into your womb which then allows me, or your clinician, to see inside your womb," explains Miss Ghosh.

You can have the procedure done as an outpatient visit while awake, or under general anesthesia as a day case—your doctor will discuss which option is best for your situation. A diagnostic hysteroscopy typically takes no more than 20 minutes, while an operative hysteroscopy (where instruments are used to treat problems like removing polyps) may take longer.

During the exam, your clinician can take a small tissue sample (biopsy) if needed for further analysis under a microscope. The results of what your doctor sees can often be discussed right away, though biopsy results come back at a later appointment.

How Should You Prepare, and What's Recovery Like?

Preparation is minimal, which makes this procedure convenient for most people. You can eat and drink normally unless your doctor tells you otherwise. However, your doctor will ask important questions beforehand: about your menstrual cycle, current medications, whether you've had recent unprotected sex, and if there's any chance you might be pregnant. "Prior to a hysteroscopy, you may be asked to take a pregnancy test," notes Miss Ghosh. "If you are pregnant, we may have to move the procedure to a later date as it could cause a miscarriage in early pregnancy".

To minimize discomfort during the procedure, Miss Ghosh recommends taking over-the-counter pain relief about an hour beforehand: "I advise women who are having an outpatient hysteroscopy in the clinic, to take paracetamol or ibuprofen an hour beforehand. This helps to reduce any cramping".

Recovery is straightforward for most women. "Most patients go home the same day and return to normal activities quickly," explains Miss Ghosh. "You might have mild cramping or light bleeding for a few days; this is completely normal. Simple pain relief and/or a hot water bottle as well as rest are usually all that's needed".

While a hysteroscopy might seem daunting if you're already dealing with fertility struggles or miscarriage, it's actually one of the most routine and safe gynecological procedures available. The real value lies in what it can reveal: "Knowing what's happening in your body can be empowering; it can help to put your mind at ease or help you to take the next steps to resolving any issues," says Miss Ghosh. For anyone facing unexplained fertility problems or recurrent pregnancy loss, this procedure could be the key to finally getting answers and moving forward with a treatment plan.