Hysteroscopy – why it’s essential before IVF

22 Dec Hysteroscopy – why it’s essential before IVF

A hysteroscopy before IVF treatment is a must. It won’t always be recommended, but have one anyway. A hysteroscopy is the best way to check your uterus is healthy and ready to carry a baby. It can spot things an ultrasound scan can’t.

So what happens during a hysteroscopy? First, you’ll be sedated or put under general anaesthesia. Then a narrow tube, with a telescope at the end, is passed through your vagina and cervix into your uterine cavity, which is sometimes filled with fluid or gas. The images are viewed on a screen and recorded.

The surgeon can then check for fibroids, polyps, scar tissue, septa and other malformations. These can usually be sorted out at the same time – i.e. your hysteroscopy changes from being diagnostic to operative.

A hysteroscopy is a straightforward, if invasive, procedure. For IVF patients, it’s really sensible to have one before treatment. Especially if you’ve had recurrent miscarriages or implantation issues. And don’t rely on an HSG. You’ve got to get up close and personal. For uterine analysis. hysteroscopy is the gold standard.

The importance of a hysteroscopy before IVF was identified in an early study of hysteroscopy and reproductive techniques. Out of 292 women who had failed IVF cycles, 25 per cent were found to have uterine problems. These were treated by operative hysteroscopy. Improved conception rates for this group ranged from 19 to 72 per cent.

But a larger study from 2015 into hysteroscopy and IVF found that a hysteroscopy before an IVF cycle didn’t improve live birth rates. And a 2019 study into recurrent implantation failure found that a pre-IVF hysteroscopy boosted implantation and pregnancy rates, but not live births.

So should IVF patients have a hysteroscopy or not? We can accept that a routine hysteroscopy before every IVF cycle is over-the-top. But no study is conclusive, and every patient is different. Your fertility clinic is best placed to advise because it provides personalised care.

For first-time IVF patients with clear, or suspected, past pregnancy problems, a hysteroscopy still seems sensible. We have seen problematic polyps and fibroids confirmed and successfully treated in hysteroscopies. Then, successful IVF cycles.

Side effects after a hysteroscopy are rare. Infections happen in less than 0.4 per cent of cases. And there’s a small chance of bleeding. More common side effects include a feeling of being bloated, and period-like cramping.

Your objective is to have a baby as soon as possible. Push for a hysteroscopy before you start your IVF treatment if you’ve had a past miscarriage or implantation issue. We did, a tiny polyp was removed, and we went on to have successful treatment.